Original Medicare vs. Medicare Advantage: Which Should You Trust Your Health To?
If you already have Medicare Parts A and B (or soon will), you can choose to receive your Medicare benefits via a Medicare Advantage plan with a private insurance company. But is Medicare Advantage a better option than Original Medicare? There’s no one-size-fits-all answer, but Medicare Advantage typically has lower premiums and optional coverage, while Original Medicare often gives you more choice when it comes to choosing doctors.
Medicare Part A
Medicare Part A covers inpatient care in hospitals, skilled nursing facilities, hospice care, and limited home healthcare services. Most people do not pay a premium for Part A, as long as they or their spouse paid sufficient Medicare taxes while working. The Medicare Part A deductible is $1,632 in 2024, rising to $1,676 in 2025.
Medicare Part B
Medicare Part B covers outpatient care, preventive services, medical supplies, and various doctor services. Part B requires a monthly premium, which is $174.70 in 2024 for individuals who earn $103,000 or less ($206,000 for people who file joint tax returns). The premium is $185.00 in 2025 for individuals who earn $106,000 or less ($212,000 for people who file joint tax returns). The Medicare Part B deductible is $240 in 2024, rising to $257 in 2025.
Both Parts A and B charge coinsurance amounts or copays once you’ve met the deductible, meaning you’ll still have to pay some out-of-pocket expenses for care. Original Medicare does not cover most prescription drugs, dental care, vision care, or hearing aids. It also does not place a limit on your annual maximum out-of-pocket expenses (unless you buy a separate Medicare supplement plan—called Medigap—that does).
Part D Prescription Drug Coverage
If you have traditional Medicare and want prescription drug coverage, you’ll need to purchase a Part D prescription drug plan. Part D is a stand-alone prescription drug plan offered by private insurance companies approved by Medicare. The average total Medicare Part D monthly is expected to drop to $46.50 in 2025, down from $53.95 in 2024. Medicare Advantage drug coverage premiums are lower than standalone Part D premiums and are also expected to fall from $15.56 in 2024 to $13.50 in 2025.
Each plan has a list of covered drugs (a “formulary”) and may have different pricing tiers, copayments, or coinsurance.
Medicare Supplement Plans (Medigap)
Medigap policies are sold by private insurance and help cover some of Original Medicare’s out-of-pocket costs, such as deductibles, copayments, and coinsurance. They are only available if you’re enrolled in Original Medicare. (If you have a Medicare Advantage plan, you can’t get a Medigap policy.)
Medigap policies are standardized, meaning that policies for each plan type offer the same benefits, regardless of the insurance company. Still, premiums for Medigap policies can vary, even for the same standardized plan, and may be more expensive if you miss Medigap open enrollment.
Differences Between Original Medicare and Medicare Advantage
Provider networks: With Original Medicare, you can see any doctor or specialist that accepts Medicare, without the need for a referral. Most Medicare Advantage plans have a provider network, which restricts your choice of healthcare providers.
Maximum out-of-pocket costs: Original Medicare has no out-of-pocket maximum, while Medicare Advantage plans have annual out-of-pocket limits ($8,850 for 2024 for in-network services).
This means that once you reach the limit, a Medicare Advantage plan will cover 100% of your Medicare-approved expenses for the rest of the year.
Part D prescription drug coverage: Original Medicare does not include prescription drug coverage—you would need to purchase a separate Part D prescription drug plan. But, since most Medicare Advantage plans include drug coverage, you can avoid the extra step and expense.
Additional benefits: Most Medicare Advantage plans include dental, vision, fitness, hearing, and telehealth benefits. Original Medicare doesn’t cover these costs.
Travel considerations: Since Original Medicare doesn’t depend on a provider network, your Medicare benefits are good nationwide. However, Medicare Advantage coverage is limited to the plan’s service area, which means your plan may not cover you while traveling (except for emergency care).
Medigap: Medigap is available to Original Medicare beneficiaries only and is designed to supplement that coverage for an extra premium. However, many Medicare Advantage plans offer benefits similar to Medigap (coverage for Part A and B deductibles and coinsurance), but without the extra premium.
Prior authorizations: Medicare Advantage plans are more likely to require advance approval for coverage, and this can lead to coverage delays.
