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Over half of Medicare beneficiaries enroll in Medicare Advantage, the private insurance alternative to Original Medicare. It’s not hard to see why: Medicare Advantage plans often cover stuff that Medicare doesn’t — like some dental, vision and hearing — and most people don’t pay extra for it.
Here’s the catch: Medicare Advantage can be more expensive if you get sick. These plans often come with higher copays and deductibles. You may not be covered at all if you go out-of-network or don’t get prior approval for certain services that require it.
And unhappy Medicare Advantage customers who want to switch back to Original Medicare may find they no longer qualify for the supplemental policies to help pay their medical bills. Without Medicare Supplement Insurance (Medigap), members on Original Medicare may face even higher out-of-pocket costs.
Unfortunately, you can’t predict your future health. This can make the choice between Original Medicare and Medicare Advantage feel like a gamble, and your health care decisions shouldn’t feel like rolling the dice.
You can make an informed choice by answering a few key questions about your health and finances. The quiz below will help you figure out which Medicare option makes sense for your situation.
Compare Medicare Advantage plans
| Insurance company | NerdWallet rating | States available | Members in high-rated plans | Member experience |
|---|---|---|---|---|
| 48 states and Washington, D.C. | Medium (50% to 84%) | 3.74 (Above average) | ||
| 46 states and Washington, D.C. | Low (49% or less) | 3.82 (Above average) | ||
| 43 states and Washington, D.C. | Medium (50% to 84%) | 3.89 (Above average) | ||
| 29 states and Washington, D.C. | Medium (50% to 84%) | 3.96 (Above average) |
1. Cost of care
In general, Medicare Advantage costs less upfront and potentially more overall if you need lots of medical care. If you stick with Original Medicare, you can get supplemental insurance known as Medigap to help pay for these out-of-pocket costs. Medigap plans have higher upfront costs but cover most if not all of your expenses when you need care.
When it comes to health care costs, what worries you most?
I need to keep my fixed costs as low as possible and want the immediate savings of a lower monthly premium.
Medical bills.
The possibility of a huge, unexpected medical bill scares me. I want to be protected if I get seriously sick.
» MORE: How much does Medicare cost?
2. Provider networks
With Original Medicare, you can see any provider in the country that accepts Medicare — and almost all do. This often makes it a better option for people who live in rural areas or retirees who have multiple places they call home.
Medicare Advantage plans are similar to employer-provided group health insurance: To be covered, you typically must choose health care providers in the insurance company’s network. If you go out-of-network, your costs may not be covered or may not apply to your out-of-pocket limits. Even if your doctor is in-network now, that could change and you might not get much notice.
The network may be relatively narrow if the plan is a health maintenance organization (HMO) or somewhat broader if it’s a preferred provider organization (PPO). Also, Medicare Advantage plans are typically regional. If you move out of the area or travel to other states, you may not be covered.
Are you comfortable staying within a specific network of doctors and hospitals?
Yes.
I’m fine with researching provider networks in my area and being limited to in-network doctors.
No.
I want to be able to see any doctor in the country who accepts Medicare, without worrying about networks.
Original Medicare has deductibles, copays and coinsurance that can quickly add up. To cover these gaps, private insurers also offer supplemental plans known as Medicare Supplement Insurance, or Medigap. Medigap premiums can be as low as $30 to $40 per month. But plans with more comprehensive coverage can cost $200 or more per month, and premiums may go up as you age.
You can’t get a Medigap policy if you have Medicare Advantage, so you’ll have to cover deductibles, copays and coinsurance yourself. But the average Medicare Advantage premium is projected to be $14 per month in 2026, according to the Centers for Medicare & Medicaid Services.
4. Health status
With Original Medicare, you usually don’t need a referral to see a specialist. You can get the care you need without prior authorization as long as it’s medically necessary and covered by Medicare.
With Medicare Advantage, you often need referrals to see specialists. You may also need to get approval for certain types of care — 99% of Medicare Advantage members have to get prior authorizations for at least some services, according to KFF. The most common services that require prior authorization are inpatient hospital stays, skilled nursing facility stays and chemotherapy.
Do you have or expect to have chronic health issues that require seeing specific specialists?
Yes.
I have chronic health issues or a specific medical need, or may in the future.
No.
I'm currently healthy and don't anticipate needing complex or specialist care.
Original Medicare rarely requires preauthorization and referrals. But Medicare Advantage members (or their loved ones) may have to jump through the hoops described in question four at some point. Prior authorization requests can also be denied, which may lead to a lengthy appeals process, a lot of paperwork and delays in medical care.
Consider Original Medicare + Medigap
Based on your answers, Original Medicare with a Medigap plan might be a better fit for you than Medicare Advantage.
You value peace of mind and flexibility, and you can afford to pay a little extra each month for it. A Medigap plan can help keep your health care costs predictable.
You worry about the worst-case scenarios. You don’t want to take a big financial hit if you end up getting seriously ill or injured, and you want to be able to see the best specialists. With Original Medicare and Medigap, you’re more likely to be covered without having to jump through hoops or worry about copays.
Finally, you like having options when it comes to providers. Maybe you move around often, or you just don’t want to be limited to the provider network in your area. Original Medicare offers more flexibility than Medicare Advantage.
» MORE: Medigap vs. Medicare Advantage
Consider Medicare Advantage
Based on your answers, Medicare Advantage might be a good option for you.
You may be on a fixed income, or you simply prefer sticking to a tight monthly budget. Most plans include prescription drug coverage and perks like some dental, vision and hearing coverage, and some plans even have a $0 premium.
The immediate savings of Medicare Advantage’s lower monthly premiums is more important to you than potentially saving on out-of-pocket costs in the future. Perhaps you’re relatively healthy and think it’s unlikely you’ll ever need serious medical care.
Even if you do, you don’t mind jumping through hoops to get services covered if necessary. And as long as you stay in-network, you'll pay a maximum of $9,250 out of pocket in 2026 with Medicare Advantage.
You’re comfortable with the managed care approach to health insurance that Medicare Advantage takes, even if it means you have to stay within a provider network to get the most affordable care. You may also have an excellent Medicare Advantage network or access to a 5-star Medicare Advantage plan in your area and no plans to move.
Shopping for Medicare Advantage plans? We have you covered.
| MEDICARE ADVANTAGE is an alternative to traditional Medicare offered by private health insurers. Compare options from our Medicare Advantage roundup. | |
| Best major company | Best for size of network |
| Best government ratings | Best for low-cost plan availability |
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- 1. Centers for Medicare and Medicaid Services. Medicare Monthly Enrollment. Accessed Sep 23, 2025.
- 2. Centers for Medicare & Medicaid Services. Medicare Advantage and Medicare Prescription Drug Programs Expected to Remain Stable in 2026. Accessed Sep 26, 2025.
- 3. KFF. Medicare Advantage Insurers Made Nearly 50 Million Prior Authorization Determinations in 2023. Accessed Sep 23, 2025.
