The Big Choice: Original Medicare vs. Medicare Advantage

Which path you take will determine how you get your medical care — and how much it costs

Dena Bunis and Kimberly Lankford,

AARP

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En español

Published July 01, 2020

/ Updated October 01, 2024

Key takeaways

Original Medicare isn’t just one policy. Medicare Advantage is all in one.
Original Medicare lets you use any doctor. MA has limited networks.
Both must provide the same care. MA may cover more but restrict more.
MA premiums may be lower but other costs differ from original Medicare.
Use original Medicare anywhere in the U.S. Advantage has geographic limits.

Once you're signed up for Medicare Parts A and B, you get to choose the type of coverage that best meets your needs — original Medicare or a Medicare Advantage plan.

If you decide on federally run original Medicare, you may have several separate plans:

Part A helps pay for inpatient hospital and skilled nursing care, some home care and end-of-life hospice care.
Part B covers doctors’ services, diagnostic screenings, durable medical equipment, lab tests, outpatient care and preventive services.
You can choose to buy a separate Part D plan because original Medicare doesn’t automatically include prescription drugs.
You can buy a Medicare supplement policy, Medigap, to help with Medicare’s deductibles and copayments.

If you choose a Medicare Advantage plan, a privately issued alternative also known as Part C, you may have Part A, Part B and Part D all in one plan. In 2024, nearly 9 in 10 MA plans include prescription coverage. You’ll have different copayments and deductibles than original Medicare.

Medicare Advantage plans have become increasingly popular. Nearly 33 million people — 54 percent of eligible Medicare beneficiaries — are enrolled in an MA plan in 2024. The average enrollee has 43 plans to choose from.

“There are trade-offs in choosing one kind of coverage over the other,” says Meredith Freed, senior policy manager with KFF’s program on Medicare policy. “A Medicare Advantage plan may have zero-dollar premiums, availability of extra benefits, reduced cost sharing for many services and an out-of-pocket spending limit. Those things are attractive to people, but it also comes with provider networks and prior authorization.”

You’ll use Medicare differently depending on whether you pick original or Advantage. Here's a comparison of how each works.

The way you pay for your doctors could change

Original Medicare. You can choose any primary care doctor or specialist who accepts Medicare. You don’t need referrals to see a provider and you don’t have to worry about your doctor leaving a plan’s network.

Only 1 percent of doctors who treat adults don’t participate in Medicare; 83 percent of primary care physicians accept new Medicare patients, according to KFF, a nonpartisan health policy nonprofit. So chances are good your current doctor accepts Medicare and you won’t have to change providers.

Medicare Advantage. Similar to employer coverage with provider networks that limit you to their doctors, MA plans may not pay for out-of-network providers or your costs will increase if you want to use a doctor that isn’t in the network.

Often, you’ll have a primary care physician who directs your care, but you’ll need a referral to see a specialist. Make sure the doctors you want to see are in the plan’s network.

Both types cover the basics but vary on some ‘extras’

By law, original Medicare and Medicare Advantage plans both must provide coverage for the same medical services, including blood work; diagnostic tests, such as X-rays and other scans; doctor visits; hospitalizations; and outpatient surgery.

Original Medicare. Original Medicare won't pay for routine dental, hearing, and vision care.

Medicare Advantage. You can expect prior authorization requirements. Most Advantage plans provide some dental, hearing and vision care. Some even extend coverage to gym memberships, over-the-counter medications and transportation to the doctor’s office.

AARP Audio · Does Medigap Cover Preexisting Conditions?

What you’ll pay with Original Medicare, Medicare Advantage

Even though original Medicare and Medicare Advantage must cover the same Part A and Part B services, you may have different out-of-pocket costs.

Original Medicare. The federal government sets Medicare premiums, deductibles and coinsurance amounts for Part A and Part B. For example, you’re responsible for 20 percent of a doctor visit or lab test bill under Part B.

Most people don’t pay a premium for Part A because they or their spouse paid Medicare taxes for at least 10 years. But they do pay Part B premiums, which are $174.70 a month for most people in 2024; high earners pay more.

Often, those with original Medicare also purchase a supplemental Medigap policy to help defray out-of-pocket costs. While a Medigap policy doesn’t have an annual cap on out-of-pocket costs, it may pay for most of your deductibles and copayments.

Medicare Advantage. You’ll still pay the government-set annual Part B premium and the Part A premium, if required. Sometimes you’ll pay an additional premium for the MA plan although about three-quarters of Medicare Advantage enrollees in 2024 are in plans with no additional premiums.

But instead of paying the 20 percent coinsurance for doctor visits and other Part B services, most Medicare Advantage plans have set copay amounts for a physician visit, such as $20 or $50.

Advantage plans have an annual cap on out-of-pocket expenses: In 2024, it’s $8,850 for in-network services and $13,300 for in-network and out-of-network services when both are covered in the plan. Some plans have lower maximums.

Where you live and travel matters

Original Medicare. You can access care anywhere in the United States as long as the provider accepts Medicare.

Medicare Advantage. Plans are based around provider networks usually limited to specific geographic areas. So if you travel a lot or have a vacation home where you spend time, your care may not be covered if you go to an out-of-network provider — or you’ll pay more for care.

In addition, while Advantage plans are pretty much available throughout the U.S., the choice of plans is more limited in rural areas.

Neither original Medicare nor Medicare Advantage pays for your health care abroad.

This story, originally published July 1, 2020, has been updated to reflect the most current information.

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Dena Bunis covered Medicare, health care, health policy and Congress. She also wrote the “Medicare Made Easy” column for the AARP Bulletin. An award-winning journalist, Bunis spent decades working for metropolitan daily newspapers, including as Washington bureau chief for the Orange County Register and as a health policy and workplace writer for Newsday.

Kimberly Lankford is a contributing writer who covers Medicare and personal finance. She wrote about insurance, Medicare, retirement and taxes for more than 20 years at Kiplinger’s Personal Finance and has written for The Washington Post and Boston Globe. She received the personal finance Best in Business award from the Society of American Business Editors and Writers and the New York State Society of CPAs’ excellence in financial journalism award for her guide to Medicare.

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