• Original Medicare and Medicare Advantage both cover hospitalization, medical appointments, and other healthcare costs; however, they are not the same.
  • Original Medicare is a government-run option and not sold by private insurance companies.
  • Medicare Advantage is managed and sold by private insurance companies. These companies set the prices, but Medicare regulates the coverage options.

Original Medicare and Medicare Advantage are two insurance options for people age 65 and older living in the United States. Your medical needs, budget, and other personal lifestyle factors can all play a role in which coverage option is better for you.

In this article, we’ll explore the differences between orignial Medicare and Medicare Advantage, and how to decide which one is better for your medical needs.

Original Medicare is a government-funded medical insurance option for people age 65 and older. Many older Americans use Medicare as their primary insurance since it covers:

  • Inpatient hospital services (Medicare Part A). These benefits include coverage for hospital visits, hospice care, and limited skilled nursing facility care and at-home health care.
  • Outpatient medical services (Medicare Part B). These benefits include coverage for preventive, diagnostic, and treatment services for health conditions.

Original Medicare generally doesn’t cover prescription drugs, dental, vision or hearing services, or additional healthcare needs.

However, for people who have enrolled in original Medicare, there are add-ons such as Medicare Part D prescription drug coverage and Medicare supplement (Medigap) plans that can offer additional coverage.

Medicare Advantage (Part C) is an insurance option for people who are already enrolled in Medicare Part A and Part B.

Medicare Advantage plans are offered through private insurance companies, and many plans cover hospital, medical insurance, and additional services such as:

Medicare Advantage takes the place of original Medicare add-ons, such as Part D and Medigap.

Instead of having multiple insurance plans to cover medical costs, a Medicare Advantage plan offers all your coverage in one place.

Original Medicare and Medicare Advantage differ in their coverage, costs, and benefits. When comparing your options, there’s no “one plan fits all.”

Medical services

If you’re someone who rarely visits the doctor, Medicare and Medicare add-ons may cover most of your needs.

However, if you’re someone who wants coverage for yearly dental, vision, or hearing exams, many Medicare Advantage plans offer this type of coverage.

Health conditions

If you have a chronic health condition, such as cancer, chronic heart failure, stroke, dementia, or others, it’ll affect your medical coverage.

For example, Medicare may not cover all your needs, but a Medicare Advantage Special Needs Plan could help with long-term costs.

These plans are designed for people with one of several chronic health conditions. They offer:

  • coverage for specialists and case managers
  • access to medications specifically for your condition
  • access to other benefits

Research has shown that Medicare Advantage plans can help consumers save more money on certain medical necessities, such as laboratory tests and medical equipment.

Medications

Original Medicare generally doesn’t cover prescription drug costs. To receive coverage for prescription drugs, you need a Medicare Part D plan or Medicare Advantage plan with prescription drug coverage.

No matter what option you choose, you’re required to have some form of prescription drug coverage within 63 days of enrolling in Medicare, or you’ll be required to pay a permanent late enrollment penalty.

Budget

If you have Medicare, you’ll pay a monthly premium for Part A (if you don’t qualify for premium-free Part A) and Part B, yearly deductibles for parts A and B, and other costs if you buy add-on coverage.

If you have Medicare Advantage, you may need to pay additional costs as well, depending on the plan you choose. Before deciding on the type of Medicare plan you want, consider what out-of-pocket costs you can afford each year.

Provider preference

While Medicare offers the freedom to choose any provider within the Medicare network, most Medicare Advantage plans don’t provide as much freedom.

Depending on the type of Medicare Advantage plan you have, you may face additional costs for out-of-network services, as well as specialist referrals and visits.

Travel frequency

For some people, travel is a way of life. This is especially true for people who retire and choose to travel or who live someplace warmer during the colder months.

If you travel frequently, consider what out-of-state medical needs you may have. In most cases, Medicare coverage is nationwide, while Medicare Advantage plans require you to stay in your local area for medical services.

To decide whether original Medicare or Medicare Advantage is better for you, it’s important to know what each plan covers.

Below you’ll find a comparison of the benefits Medicare vs. Medicare Advantage offer:

CoverageOriginal MedicareMedicare Advantage
hospitalizationyesyes
medicalyesyes
prescription drugsno
(optional Part D)
yes (most plans)
dental noyes (most plans)
visionnoyes (most plans)
hearingnoyes (most plans)
provider freedomyesNo
out-of-state coverageyesNo
yearly out-of-pocket
maximum
noyes
health benefit perksnoyes (some plans)

For some people, Medicare Advantage plans can help save money on long-term medical costs, while others prefer to pay for only what they need with Medicare add-ons.

Below you’ll find an estimated cost comparison for some of the fees associated with Medicare vs. Medicare Advantage in 2021:

CostOriginal Medicare amount
Part A monthly premium$0, $259, or $471 (depending on how long you’ve worked)
Part A deductible$1,484 each benefit period
Part A coinsurance$371–$742+ per day (depending on the length of your stay)
Part B monthly premium$148.50
Part B deductible$203 per year
Part B coinsurance20% of all approved medical services after deductible is met
Cost Medicare
Advantage amount
Part B monthly premium$148.50
Medicare Advantage plan monthly premiumvaries (can start at $0)
Medicare Advantage plan deductiblevaries (can start at $0)
Medicare Advantage plan drug deductiblevaries (can start at $0)
Medicare Advantage plan coinsurance
/copayments
varies (generally, $0–$50+ per visit)
maximum out-of-pocket yearly cost$3.400–
$10,000+

Enrolling in Medicare is a time-sensitive process that you should begin roughly 3 months before your 65th birthday to ensure that you don’t have a gap in your coverage.

If you receive social security benefits, you’re automatically enrolled in Medicare Part A and B.

You can also apply for Medicare 3 months before your 65th birthday and up to 3 months after you turn age 65. If you decide to wait to enroll until after that period, you may face late enrollment penalties.

When you apply for Medicare, you’ll need to have some important personal information handy.

This includes your place and date of birth, Medicaid number, and any current health insurance information. Once you have this information, you can apply on the Social Security Administration website.

You won’t be able to enroll in a Medicare Advantage plan until you have been enrolled in Medicare Part A and B.

To find a list of Medicare Advantage plans or Part D plans near you, use the 2021 Medicare plan finder tool.

Finding a health insurance plan that covers all your medical needs is based entirely on your personal situation.

Both original Medicare with add-ons and Medicare Advantage offer coverage, costs, and benefits to fit your needs.

When comparing which option is better for you, be sure to consider:

  • your medical situation
  • monthly and yearly budget
  • preference for providers
  • other lifestyle factors that can impact your care and costs

You don’t have to wait until you apply for Medicare to begin shopping around for plans in your area. Get a head start on choosing the best health insurance plan for 2021 right now.

This article was updated on November 20, 2020, to reflect 2021 Medicare information.

Healthline