Original Medicare vs. Medicare Advantage: How to Choose
Original Medicare lets you see any provider that accepts Medicare, while Medicare Advantage may be a better option if you can’t afford a Medigap plan.
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Lead Writer & Content Strategist Original Medicare is government health insurance for people who are 65 and older or living with certain disabilities. Medicare Advantage, also called Medicare Part C, is a bundled alternative sold by private insurers. Both options provide coverage for your major medical needs.
But Medicare Advantage and Medicare differ in how much they cost and where you can get care.
Here's what you should know.
What's the difference between Original Medicare and Medicare Advantage?
| Original Medicare | Medicare Advantage |
| ✅ See any doctor in the U.S. that takes Medicare. | ❌ Limited to providers in your plan’s network for most affordable care. |
| ✅ Specialist visits without a referral. | ❌ No specialist visits without a referral. |
| ❌ Prescription drug coverage not included (must add on). | ✅ Prescription drug coverage usually included. |
| ❌ No cap on out-of-pocket costs. | ✅ Cap on out-of-pocket costs. |
| ✅ Medicare Supplement Insurance (Medigap) can be added to minimize out-of-pocket costs. | ❌ Medigap cannot be added to cover out-of-pocket costs. |
| ❌ Dental, vision and hearing coverage not included. | ✅ Dental, vision and hearing coverage sometimes included. |
Original Medicare
Original Medicare includes Part A (hospital insurance) and Part B (medical insurance). You can add a Part D (prescription drug plan) and/or Medicare Supplement Insurance (Medigap), but they aren’t included.
- Part A covers things like inpatient hospital care, skilled nursing facility care, hospice care and some home health care.
- Part B covers things like doctor’s visits, preventive services and durable medical equipment.
- Part D (optional) covers generic and brand-name prescription drugs.
- Medigap (optional) covers certain deductibles, copays and coinsurance that Medicare doesn’t cover. With Medigap coverage, you may pay little to nothing out of pocket when seeking care.
If you opt for Original Medicare, it’s a good idea to get a Part D plan so you’re covered for prescription drugs. It’s also smart to add a Medigap plan to cover potentially pricey out-of-pocket costs.
Under Original Medicare, you can go to any medical provider in the country that accepts Medicare, and you don’t need a referral to see a specialist .
» MORE: How much does Medicare cost?
Shopping for Medicare plans? We have you covered.
Medicare Advantage is an alternative to traditional Medicare offered by private health insurers. It covers the same benefits as Medicare Part A and Part B.
- States available48 states and Washington, D.C.
- Members in high-rated plansMedium (50% to 84%)
- Member satisfactionAverage
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- States available46 states and Washington, D.C.
- Members in high-rated plansLow (49% or less)
- Member satisfactionAbove average
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Medicare Advantage
Medicare Advantage is an alternative to Original Medicare sold by private insurance companies. It combines Medicare Part A and Part B. Most plans also include Medicare Part D prescription drug coverage and additional benefits like some dental and vision coverage.
Many Medicare Advantage plans have no premium. However, you’ll still be responsible for paying your Part B monthly premiums .
Medicare Advantage plans work like employer health insurance plans, with provider networks and costs for getting medical care, such as deductibles, copays and coinsurance. Costs can be low if you’re healthy. But if you have a serious condition, expenses can add up. Out-of-pocket caps on spending can be as high as $9,250 in 2026.
Medicare Advantage networks and coverage can change year to year. If you have a serious health issue, you may not be able to see the specialists you prefer if they’re out-of-network.
💬 From our Nerds: What is the downside of a Medicare Advantage plan?
“With Medicare Advantage, you’re generally limited to that plan’s network of doctors and hospitals, which may not include the specialist you want to see if you get really sick. These plans also require prior authorization before some services or procedures, which can be burdensome.
"If you develop an illness, your out-of-pocket costs can be quite high on some Medicare Advantage plans. But if you can’t afford a Medigap plan, Medicare Advantage may be cheaper than paying out-of-pocket costs on Original Medicare.”
— Kate Ashford, lead writer covering Medicare
» TAKE OUR QUIZ: Are Medicare Advantage plans worth it?
Medicare vs. Medicare Advantage: Coverage
| Coverage | Original Medicare | Medicare Advantage |
| Medicare Part A and Part B coverage | ✓ | ✓ |
| Part D prescription drug coverage | Must purchase separately. | ✓ (Most plans.) |
| Ability to purchase a Medigap plan | ✓ | |
| Extra benefits like some coverage for dental, vision and hearing care | ✓ | |
| Cap on out-of-pocket costs | No cap, but a Medigap plan covers certain out-of-pocket costs. | ✓ |
🤓 Nerdy Tip
Unlike Original Medicare plans, most Medicare Advantage plans come with some dental, vision and hearing coverage, but the benefits you need might not be included. Only about 4% of Medicare Advantage enrollees have a plan with comprehensive dental coverage, according to research published by the American Medical Association in 2024 .It’s wise to compare Medicare Advantage and Medicare based on health care coverage alone. You can always buy separate dental, vision and hearing policies if desired. Medicare vs. Medicare Advantage: Provider choice
| Plan feature | Original Medicare | Medicare Advantage |
| Unlimited network of providers | ✓ | |
| No preauthorization required for specialized care | ✓ | |
| Ability to move/travel and keep your plan | ✓ | Possibly, if the Medicare Advantage plan allows. |
Medicare vs. Medicare Advantage: Cost comparison
The overall cost of Medicare Advantage vs. Medicare is determined by two factors: your monthly premium and the out-of-pocket costs that arise when you seek care.
| Original Medicare | Medicare Advantage |
| Part A: Typically $0. | Part A: Typically $0. |
| Part B: Starts at $202.90 per month in 2026. | Part B: Starts at $202.90 per month in 2026. |
| Medicare Advantage (Part C): N/A. | Medicare Advantage (Part C): Varies by plan, may be $0. |
| Part D: Varies by plan; average is $34.50 in 2026 for total monthly premium. | Part D: Usually included in the plan. |
| Medigap: Varies by plan. | Medigap: N/A. |
Medicare vs. Medicare Advantage out-of-pocket costs
| Original Medicare | Medicare Advantage |
| If you seek medical care: You’ll be responsible for deductibles and coinsurance for Medicare Part A and Part B. However, you can buy a Medigap plan that will cover many Part A and Part B out-of-pocket costs. | If you seek medical care: You’ll be responsible for deductibles, copays and coinsurance as described by the plan. |
| Out-of-pocket max: There’s no out-of-pocket max for Original Medicare. However, if you have a Medigap plan, you’ll be covered for many out-of-pocket expenses. | Out-of-pocket max: Up to $9,250 in 2026. |
Even if you have a Medicare Advantage plan, you must pay your Medicare Part B premium, which is $202.90 per month in 2026. Some Medicare Advantage plans cover part or all of this cost. For most people, Medicare Part A is free.
How to choose between Medicare Advantage and Medicare
Consider your health, budget and lifestyle when choosing between Medicare Advantage and Medicare. Think about the future, too, and remember your health status can change at any time.
Consider Original Medicare if you:
- Want provider flexibility. With Original Medicare, you can see any medical provider or visit any facility in the country that accepts Medicare. You also don’t need preauthorization to see specialists.
- Are a frequent health care user. If you have a chronic condition or need regular care, you have more choices with Original Medicare. You also have the option to buy a Medigap plan, which will lower your out-of-pocket costs. It can be difficult to get a Medigap plan once you pass your initial Medigap open enrollment window.
- Can afford a Medicare Supplement Insurance plan. Some people choose Medicare over Medicare Advantage so they can get Medigap. If you need significant care, you could be on the hook for thousands of dollars in deductibles, copays and coinsurance. Medigap plans cover many of these out-of-pocket costs.
- Plan to spend your retirement traveling. A downside of Medicare Advantage plans is they usually limit you to care providers within a geographic service area. Once you get outside that area, you’re only covered for emergency care. Original Medicare offers access to a national network of providers — no matter where you are in the U.S.
- Like to minimize risk. There’s always the possibility of developing a serious medical issue later. If this happens, you may want to seek care from the best specialists. Original Medicare gives you the flexibility to do that, while Medicare Advantage limits you to whoever is in-network — and you’ll need a referral to see a specialist.
Consider Medicare Advantage if you:
- Live in an area with a broad network. Check to see if there are Medicare Advantage plans in your area with a wide network of providers and a few top-notch hospitals. If this is the case, and you don't plan to move, Medicare Advantage may be a better deal.
- Can’t afford a Medicare Supplement Insurance plan. If you can’t afford Medicare Supplement Insurance, it may be better to have Medicare Advantage than only Medicare without Medigap. Medicare Advantage offers many $0-premium plans. But you’ll still be responsible for your Medicare Part B premiums and any out-of-pocket costs up to your plan’s cap — which could be as high as $9,250 in 2026. If you have expensive medical needs, paying a monthly Medigap premium will often be more affordable.
- Don’t mind getting referrals. Medicare Advantage plans often limit you to the providers within their network. If you’re allowed to go out-of-network, you’ll likely need preauthorization and your care will usually be more expensive.
» MORE: Best Medicare Advantage plans
Can you drop your Medicare Advantage plan and go back to Original Medicare?
If you sign up for a Medicare Advantage plan when you first enroll in Medicare, you have the option of switching to Original Medicare in the first three months. After that, you can drop your Medicare Advantage plan and return to Original Medicare during two annual open enrollment periods
- Medicare open enrollment: Oct. 15 to Dec. 7.
- Medicare Advantage open enrollment: Jan. 1 to March 31.
You can also switch back to Original Medicare during a special enrollment period if you have certain life events, like moving out of your plan’s service area.
There’s no penalty for switching plans during an enrollment period, but if you want to buy a Medigap plan, it can be denied or cost more based on your health conditions.
Switching from Medicare Advantage to Medicare with Medigap
You have six months to buy Medigap, starting from the first month you enroll in Medicare Part B and are 65 or older. During this period, insurance companies can't charge you more because of your health . But afterward, insurers can charge you more or deny you coverage based on your health history. (This is true unless you live in Connecticut, Massachusetts, Maine or New York.)
So if you choose a Medicare Advantage plan, you may not be able to switch back to Original Medicare with a Medigap plan later on, or it may cost more.
It’s important to think carefully about whether you may eventually need the coverage Medigap offers before choosing Medicare Advantage. If your health declines in the future, you may face significant out-of-pocket costs, and you might not qualify for Medigap anymore.
» MORE: Medicare Advantage vs. Medigap
Choosing your Medicare coverage is a big decision. If you’re overwhelmed, a financial planner or Medicare consultant can help guide you.
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- 1. Centers for Medicare & Medicaid Services. Compare Original Medicare & Medicare Advantage. Accessed Jul 15, 2025.
- 2. Centers for Medicare & Medicaid Services. What does Medicare cost?. Accessed Jul 15, 2025.
- 3. American Medical Association. Availability of Dental Benefits Within Medicare Advantage Plans by Enrollment and County. Accessed Jul 15, 2025.
- 4. Centers for Medicare & Medicaid Services. Get ready to buy: Your Medigap Open Enrollment Period. Accessed Jul 15, 2025.
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| Insurance company | NerdWallet rating | Plan types offered | NAIC complaint rate | Premium discounts available |
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| A, C, D, F, G and N | Far fewer than expected | Below average | ||
| A, B, C, F, G, K, L and N | Far fewer than expected | Above average | ||
| A, F, G and N | Far more than expected | Above average | ||
| A, F, G and N | Far fewer than expected | Above average |
