Original Medicare vs. Medicare Advantage: How to Choose

When choosing between Medicare and Medicare Advantage, you’ll want to consider cost, coverage and ease of use, among other things. Your decision will depend on your location, your current and potential health care needs and your financial situation.

One of the biggest differences between Original Medicare and Medicare Advantage is that Original Medicare is administered by the federal government and Medicare Advantage is sold by private health insurance companies. However, both options provide coverage for your major medical needs.

On Original Medicare, you can see any doctor in the U.S. that accepts Medicare, while on Medicare Advantage, you’re generally limited to the doctors and hospitals in that insurance company’s network.

Here's what you should know.

What's the difference between Original Medicare and Medicare Advantage?

Original Medicare

Medicare is government health insurance coverage provided to people age 65 and older and younger people living with certain disabilities. Original Medicare includes two parts: Part A and Part B, which cover different aspects of your health care:

• Part A is hospital insurance, covering things like inpatient hospital care, skilled nursing facility care, hospice care and some home health care.

• Part B is medical insurance, covering things like doctor’s visits, preventive services and durable medical equipment.

Under Original Medicare, you can see any medical provider or use any medical facility in the country that accepts Medicare^[0]

Medicare Supplement Insurance (Medigap)

There’s also Medicare Supplement Insurance, or Medigap, which is additional insurance you can buy from private health insurance companies to cover certain deductibles, copays and coinsurance that Medicare doesn’t cover. Experts recommend buying a Medigap plan if you opt for Original Medicare.

You can buy a Medigap plan during the six-month period that starts once you’ve turned 65 and have enrolled in Medicare Part B, and your health and medical history can’t be factored into insurers’ pricing or coverage decisions^[0]

In other words, if you choose a Medicare Advantage plan, you may not be able to switch back later to Original Medicare with a Medigap plan.

» MORE: Medicare Advantage vs. Medigap

Medicare Advantage

Medicare Advantage — also called Medicare Part C — is an alternative to Original Medicare sold by private insurance companies, combining Medicare Part A and Part B and usually offering additional benefits like some dental and vision coverage. Most Medicare Advantage plans also include Medicare Part D prescription drug benefits. Many plans have no premium; however, you’ll still be responsible for paying your Part B monthly premiums^[0]

Medicare Advantage plans work like employer health insurance plans, with provider networks and costs for getting medical care, such as deductibles, copays and coinsurance. Costs can be low if you’re healthy, but if you have a serious condition, expenses can add up. Out-of-pocket caps on spending can be as high as $9,350 in 2025^[0]

Medicare Advantage networks and coverage can change year to year. If you have a serious health issue, you may not have access to the specialists you prefer if they’re out-of-network.

» MORE: What does ‘medically necessary’ mean for Medicare coverage?

Medicare vs. Medicare Advantage: Coverage features

Medicare vs. Medicare Advantage: Cost

Your overall costs for Original Medicare or Medicare Advantage depend on how often you seek medical care and whether you have (or can purchase) a Medigap plan.

Do you still pay Medicare premiums with a Medicare Advantage plan?

Even if you have a Medicare Advantage plan, you’ll be responsible for paying your Medicare Part B premium, which is $174.70 per month in 2024 ($185 in 2025). Some Medicare Advantage plans cover part or all of this cost. For most people, Medicare Part A is free.

How to choose between Medicare and Medicare Advantage

The choice between Original Medicare and Medicare Advantage should take into account your financial situation and your health status now and what it might be in the future, plus how much flexibility you want in your medical providers.

Consider Original Medicare if you:

• Want provider flexibility. With Original Medicare, you can see any medical provider or visit any facility in the country that accepts Medicare.

• Are a frequent health care user. If you have a chronic health condition or otherwise seek regular health care, you have more choices for care on Original Medicare. You also have the option to purchase a Medigap plan, which will cover certain deductibles, copays and coinsurance for treatment under Medicare Part A and Part B. Once you pass your initial Medigap open enrollment window, it can be difficult to get a Medigap plan later.

• Can afford a Medicare Supplement Insurance plan. Original Medicare has no cap on out-of-pocket costs, meaning if you need significant care, you could be on the hook for thousands of dollars in deductibles, copays and coinsurance. Medigap plans cover certain out-of-pocket costs.

• Plan to spend your retirement traveling. Medicare Advantage plans typically require that you use care providers within a geographic service area, and once you get outside that area, you’ll be covered for emergency care only. Original Medicare offers access to a national network of providers — no matter where you are in the U.S.

• Like to minimize risk. Although Medicare Advantage can work for many people, there’s the possibility of developing a serious medical issue later. People often want to seek care from the best specialists — who may not be in their plan’s network — or are surprised by the high costs of their copays and coinsurance.

Consider Medicare Advantage if you:

• Live in an area with a broad network. If there are Medicare Advantage plans in your area with a wide network of providers, including a few top-notch hospitals, you’ll have more options when it comes to your health care decisions.

• Can’t afford a Medicare Supplement Insurance plan. If you can’t afford the out-of-pocket costs for a Medigap plan, Medicare Advantage offers many $0-premium plans. But you’ll still be responsible for any deductibles, copays and coinsurance that are required if you seek medical care — up to the out-of-pocket maximum of the plan — which could be as high as $9,350 in 2025. You’re also still responsible for your Medicare Part B premiums. If you have expensive medical needs, paying a monthly Medigap premium will often be more affordable.

• Don’t mind getting referrals. Medicare Advantage plans often limit you to the providers within their network. If you’re allowed to go out-of-network, you’ll likely need preauthorization and your care will usually be more expensive.

Can you drop your Medicare Advantage plan and go back to Original Medicare?

You can drop your Medicare Advantage plan and return to Original Medicare at the following times:

• Medicare open enrollment: Once you’ve signed up for Medicare, you can join a Medicare Advantage plan, switch plans or drop your plan for Original Medicare between Oct. 15 and Dec. 7 each year. 

• Medicare Advantage open enrollment: If you have Medicare Advantage, you can switch plans or drop your Medicare Advantage plan for Original Medicare between Jan. 1 and March 31 each year. 

• Initial enrollment period: If you sign up for a Medicare Advantage plan when you first enroll in Medicare, you have the option of returning to Original Medicare in the first three months. 

• Special enrollment period: If you have Medicare Advantage and encounter certain life situations, such as moving out of your plan’s service area, you may be able to return to Original Medicare. 

Keep in mind that your Medigap open enrollment period — the time when you can get any Medigap policy sold in your state without medical underwriting — lasts for six months after you’re 65 or older and have Medicare Part B. If you return to Original Medicare after that point, you may not qualify for a Medigap plan or it may be more expensive.