Medicare Advantage vs. Original Medicare — Which One Is Right for You?

Medicare Advantage vs. Original Medicare: What's the Difference?

Should you choose Original Medicare or Medicare Advantage? Compare networks, costs, prescriptions, supplemental coverage and more.

Medicare Advantage vs. Original Medicare: Which One Is Right for You?

One of the biggest Medicare decisions you'll face is whether to stay with Original Medicare or choose a Medicare Advantage plan.

There isn't one universally "best" choice. The better question is:

Which type of Medicare coverage fits your healthcare needs and budget?

FAQ

What is Original Medicare?

Original Medicare consists of:

• Medicare Part A

• Medicare Part B

It allows you to receive covered healthcare from providers who participate in Medicare.

What is Medicare Advantage?

Medicare Advantage, or Part C, is an alternative way to receive your Medicare benefits through a Medicare-approved private insurance plan. Most Medicare Advantage plans include prescription drug coverage.

Does Medicare Advantage replace Medicare?

Medicare Advantage is an alternative way of receiving your Medicare benefits, but you remain enrolled in Medicare.

Which option gives me more provider flexibility?

Generally, Original Medicare can offer broad access to Medicare-participating providers. Medicare Advantage plans often use provider networks, and the rules differ between plans.

Do Medicare Advantage plans have an out-of-pocket maximum?

Yes. Medicare Advantage plans have a yearly limit on what you pay for covered Medicare services. Once you reach the plan's limit, the plan pays 100% for covered services for the remainder of the year.

Does Original Medicare have an annual out-of-pocket maximum?

Original Medicare itself generally does not have a yearly out-of-pocket maximum unless you have supplemental coverage such as Medigap, Medicaid or certain employer/retiree coverage.

Can I add Medigap to Medicare Advantage?

No. Medigap is designed to supplement Original Medicare. You generally cannot use Medigap to pay Medicare Advantage copayments, deductibles or premiums.

What about prescription drugs?

With Original Medicare, you can generally add a separate Part D prescription drug plan. Most Medicare Advantage plans include Part D.

Which is cheaper (Medicare Advantage vs Original Medicare)?

There isn't one answer. A plan with a $0 monthly premium can still have deductibles, copayments, coinsurance and other costs. Likewise, Original Medicare combined with supplemental coverage can involve multiple premiums.

The important question is your overall expected healthcare cost, not just the monthly premium.

Which should I choose?

Consider:

Original Medicare + supplemental coverage if you value:

• Provider flexibility

• A traditional Medicare structure

• Potentially predictable supplemental coverage

Medicare Advantage if you value:

• An all-in-one plan structure

• A yearly out-of-pocket maximum

• Potential additional benefits

• Integrated prescription coverage

These are general considerations, not individualized recommendations.

JRF Services Medicare Tip

Don't choose based on advertising alone.

Compare the plan against your actual doctors, prescriptions and healthcare habits.