When you start thinking about healthcare in retirement, Medicare becomes one of the most important decisions you’ll face. But Medicare isn’t just one program—there are two main ways to get your coverage: Original Medicare and Medicare Advantage. These two paths offer very different approaches to managing your health and your wallet.
Understanding Original Medicare
Original Medicare is the traditional, government-run version of Medicare. It consists of Part A and Part B. Part A covers your hospital-related care, including inpatient stays, skilled nursing facility care, some forms of home health care, and hospice services. Meanwhile, Part B handles your medical needs, such as doctor visits, outpatient services, preventive screenings, and some home healthcare services.
With Original Medicare, you have the flexibility to see any doctor or healthcare provider in the country, as long as they accept Medicare. You don’t need a referral to see a specialist, which makes navigating your care relatively simple. That said, this flexibility comes with a few gaps that can leave you paying out-of-pocket.
What Original Medicare Doesn’t Cover
Original Medicare does not cover prescription drugs by default. If you want drug coverage, you need to enroll in a separate plan known as Part D. In addition, it doesn’t pay for routine dental check-ups, vision exams, eyeglasses, hearing aids, or hearing exams—services many people need regularly as they age.
You’re also responsible for 20% of your outpatient medical costs after meeting the annual Part B deductible. Because of these costs, many beneficiaries purchase a Medigap policy, which helps cover deductibles, copayments, and coinsurance not paid by Original Medicare. These supplemental plans can make healthcare more predictable but come at an extra monthly cost.
Exploring Medicare Advantage
Medicare Advantage, also called Part C, is a bundled alternative to Original Medicare offered through private insurance companies approved by Medicare. These plans are legally required to provide the same coverage as Original Medicare (Parts A and B), but most include additional benefits like prescription drug coverage, vision, dental, and hearing services.
These plans often work like Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs). That means you might need to choose doctors and hospitals within the plan’s network, and in many cases, you’ll need a referral to see a specialist. However, this structure allows providers to offer extra benefits and sometimes lower monthly premiums.
The Key Differences Explained
One of the biggest differences between Original Medicare and Medicare Advantage is provider flexibility. Original Medicare lets you go to nearly any provider nationwide, while Medicare Advantage plans often require you to stick to a regional network. This can make a big difference if you travel frequently or split time between multiple states.
Another major difference lies in out-of-pocket costs. Original Medicare doesn’t have an annual cap on how much you can spend, unless you purchase a Medigap policy. Medicare Advantage plans, on the other hand, must have an annual out-of-pocket limit (in 2024, that cap is $8,850), offering a safety net if your medical expenses spike.
When it comes to extra benefits, Medicare Advantage plans usually win. Many of these plans offer things like gym memberships, meal delivery after hospital stays, transportation to medical appointments, and expanded telehealth services. These perks are generally not available with Original Medicare unless you pay for them separately.
Comparing the Costs
Cost-wise, Original Medicare can appear straightforward but often ends up costing more when you add up premiums for Part B, a Part D drug plan, and a Medigap policy. For example, in 2024, the standard Part B premium is $174.70 per month. A Part D drug plan could run about $30 to $40 per month, and Medigap plans can range anywhere from $100 to over $300 depending on your location and the plan you choose.
Medicare Advantage plans may have $0 premiums beyond your Part B cost, and many include drug coverage and extra benefits all in one package. But don’t let the $0 tag fool you—copays for services can add up, especially if you need frequent care or specialist visits. Still, the annual cap on out-of-pocket costs can give peace of mind for those worried about unexpected medical bills.
Who Might Prefer Original Medicare?
Original Medicare tends to be a better option for people who prioritize flexibility and nationwide access to providers. If you travel often or spend months each year in another state, this plan structure will suit your lifestyle better. It also makes sense for people who see multiple specialists, since you don’t need referrals and you can choose your providers freely.
You might also prefer Original Medicare if you want the stability of a Medigap plan that helps manage costs predictably over time. While monthly premiums are higher, you’ll avoid big surprise bills from coinsurance or deductibles.
When Medicare Advantage Makes More Sense
Medicare Advantage works well for people who are comfortable using in-network providers and want extra benefits without juggling multiple plans. It’s an especially attractive option if you’re relatively healthy and want a lower monthly bill. For many, having all-in-one coverage—with prescription drugs and preventive dental and vision included—feels more like a modern health insurance plan.
These plans are also convenient for those who value things like wellness programs, hearing aid coverage, or even over-the-counter drug stipends. If you’re budget-conscious and willing to trade a bit of flexibility for bundled savings, Medicare Advantage could be a solid fit.
What About Changing Your Mind?
You’re not stuck with one choice forever. Medicare gives you several windows to change your plan. When you first become eligible—around your 65th birthday—you have a 7-month window to enroll. After that, there’s an Annual Enrollment Period from October 15 to December 7 where you can switch between Original Medicare and Medicare Advantage or change drug plans.
There’s also a Medicare Advantage Open Enrollment from January 1 to March 31, where you can switch from one Advantage plan to another or go back to Original Medicare. But if you’re switching from Medicare Advantage back to Original Medicare and want to add Medigap, be aware you might not be guaranteed acceptance outside of your initial enrollment period.
Which One Is Right for You?
There’s no single “best” Medicare plan for everyone. If you value freedom, predictability, and nationwide provider access, Original Medicare with a Medigap policy is likely your best bet. On the other hand, if you’re looking for lower monthly costs, all-in-one coverage, and extras like dental and vision, a Medicare Advantage plan might be a better fit.
Choosing between the two comes down to your healthcare needs, your travel habits, and how much financial risk you’re willing to carry. Take the time to compare your options during open enrollment—and don’t hesitate to ask questions or talk to a licensed Medicare advisor before you commit.
