Original Medicare and Medicare Advantage are two ways to receive Medicare hospital and medical benefits. Neither is automatically the right choice for everyone. This comparison focuses on medical coverage; review every part of your insurance needs before enrolling.
Compare how you receive care
| Question | Original Medicare | Medicare Advantage |
|---|---|---|
| Who provides the coverage? | The federal Medicare program for Parts A and B | A private plan that contracts with Medicare |
| Which providers can I use? | Doctors and hospitals that take Medicare, generally throughout the U.S. | Plan network rules apply; check each provider and location |
| Is there an annual medical spending limit? | No annual limit unless other coverage helps | A yearly limit for covered Part A and Part B services, with plan-specific rules |
Look beyond the monthly premium
Estimate what you might pay in a year with specialist visits, outpatient care or a hospital stay. Include premiums, deductibles and medical cost sharing. A plan with a $0 plan premium can still have other costs; you generally continue paying your Part B premium. An out-of-pocket limit does not mean every expense counts toward it.
Where Medigap fits
Medigap is separate insurance that may help pay certain costs in Original Medicare. It is not Medicare Advantage and cannot be used to pay Medicare Advantage cost sharing. Check your right to buy a Medigap policy before leaving a Medicare Advantage plan; acceptance is not guaranteed in every situation.
Make the comparison personal
- Verify your actual doctors and hospitals, including the office addresses you use.
- Read referral and prior-authorization requirements for expected care.
- Consider travel and care you receive away from home.
- Review the Summary of Benefits and Evidence of Coverage for the correct year.
- Confirm the enrollment opportunity and effective date before changing.
Extra benefits and provider arrangements vary by plan and location. A carrier's name alone does not identify your coverage. Ask for the complete plan name and identifier when you compare.
Continue with a related question
- Medicare HMO and PPO: Networks, Referrals and Costs
- How to Compare Medigap Policies
- Changing Medicare Coverage Without Losing Track