John Kimelman is a veteran financial journalist who spent 14 years as an executive editor at Barrons.com. In that role, he supervised a staff of writers, edited and wrote online columns, and wrote feature articles and cover stories for Barronâs magazine. Previously, he worked as a staff editor and writer at CNBC.com and American Banker, the leading trade publication of the U.S. commercial banking industry.
David Schepp is a veteran financial journalist with more than two decades of experience in financial news editing and reporting for print, digital, and multimedia publications.
Whatâs the difference between Original Medicare and Medicare Advantage?
Original Medicare is run by the federal government and lets you see any doctor or hospital that accepts Medicare. Medicare Advantage plans are offered by private insurers, typically use provider networks, and often include benefits Original Medicare doesnât cover, such as dental, vision, or hearing services.
Why might you choose Original Medicare instead of Medicare Advantage?
Many people prefer Original Medicare because it offers broader choice of doctors and hospitals and usually doesnât require referrals to see specialists. It can also be paired with a Medicare Supplement Insurance (Medigap) policy and a Part D drug plan, depending on your needs.
Why might you choose a Medicare Advantage plan?
Many people choose Medicare Advantage because it bundles hospital, medical, and often prescription drug coverage into a single plan and may include benefits Original Medicare doesnât cover, such as dental, vision, or hearing care. For beneficiaries who are comfortable using provider networks and following plan rules, Medicare Advantage can feel simpler to manage than coordinating multiple policies.
Open full sized image
There are a lot of ingredients to consider as you select your Medicare plan.
Signing up for Medicare is straightforward if youâre eligible. Apply online at the Social Security Administration website (ssa.gov) or visit a regional office. Within weeks, youâll receive your red, white, and blue Medicare card in the mail.
After enrolling in Medicare, your next step is choosing a plan. Itâs a decision that requires careful consideration, whether you stick with Original Medicare, managed by the federal government, or opt for a Medicare Advantage plan offered by a private insurer in your state.
Key Points
For those new to Medicare, the most challenging decision is often whether to choose Original Medicare or a Medicare Advantage plan.
Original Medicare typically provides greater freedom when choosing doctors and other health care providers.
Medicare Advantage plans usually include a greater number of services, including dental and vision care.
Key Medicare decision: Original Medicare vs. Medicare Advantage
If you like the path of least resistance, Original Medicare might be your best bet. Think of it as Medicareâs default plan. If youâre already receiving Social Security or Railroad Retirement Board benefits, youâll be automatically enrolled in both Part A (hospital insurance) and Part B (medical insurance, which includes doctor visits). If not, youâll need to sign up for both parts through Social Security.
Parts A and B form the foundation of your health insurance coverage. You can then add a Part D drug plan and a Medicare Supplement Insurance policy (commonly known as Medigap) to help cover costs that Parts A and B donât, such as deductibles, coinsurance, and co-payments.
More than half of Medicare beneficiaries now choose Medicare Advantage, which is required to cover all medically necessary services that Original Medicare covers and typically includes additional benefits such as dental, vision, and hearing tests and aids. These plans combine services and may reduce out-of-pocket costs, but availability depends on your location.
Beneficiaries in cities and suburban areas usually have more plan options, while those in rural areas may have fewer. In 2026, the average beneficiary had access to 39 Medicare Advantage plans, although the number varies by region.
To get the ball rolling on your research, hereâs a comparison of Original Medicare and Medicare Advantage based on several key considerations. Weigh their importance against the premium youâre quoted for each choice youâre considering.
Comparing Original Medicare and Medicare Advantage
Feature
Original Medicare
Medicare Advantage
Coverage
Part A (hospital) and Part B (medical)
Includes Parts A and B, often with extra benefits such as dental and vision
Provider choice
Any doctor or hospital that accepts Medicare
Typically requires using an in-network provider
Out-of-pocket costs
No out-of-pocket maximum; Medigap can help cover costs
May include extras like hearing aids, fitness programs, and more
Note: Benefits and costs vary by plan and location.
1. Medicare costs: Premiums, deductibles, and out-of-pocket limits
Original Medicare. With Part B (medical insurance), youâll pay a monthly premium based on your income as reported on your tax return. For 2026, the standard premium is $202.90, with higher-income beneficiaries paying more. (Read more about how Part B premium costs work.) Youâll also pay an annual deductible, and after meeting it, youâll be responsible for 20% of the cost of most services (known as coinsurance).
If you choose to add a Part D drug plan, youâll be charged a separate premium, which also carries an income-based surcharge if your earnings exceed a certain threshold. Original Medicare doesnât cap out-of-pocket costs, meaning youâll continue to pay 20% coinsurance for covered services unless you purchase a supplemental Medigap policy.
Medicare Advantage. These plans often bundle Part A, Part B, and Part D coverage, with additional benefits like dental and vision. Youâll still pay the standard Part B premium and may have an additional premium, depending on the plan you choose. Out-of-pocket costs vary based on the plan and services used, but Advantage plans include an annual out-of-pocket maximum for Part A and B services. Once you hit that limit, the plan covers all costs for the rest of the year.
How to choose: Medicare Advantage plans appeal to those looking for more predictable costs, thanks to caps on annual out-of-pocket expenses, and bundled coverage, including extras like dental and vision. To find the best fit for your health care needs, compare the total cost and coverage of each plan.
2. Doctor and hospital choice: Flexibility vs. restrictions
Original Medicare. You can go to any doctor or hospital that takes Medicare, anywhere in the U.S. In most cases, you donât need a referral to see a specialist.
Medicare Advantage. These plans typically require you to use doctors and other providers within the planâs network and service area for nonemergency care. You may also need a referral to see a specialist and prior authorization for certain services or procedures.
How to choose: If having the freedom to choose any doctor is your top priority, Original Medicare may be the better option. Should you opt for a Medicare Advantage plan, be aware that PPO plans generally offer more flexibility in doctor choice compared with HMO plans.
3. Range of coverage: Whatâs included in Medicare plans
Original Medicare. Medicare covers the basics: hospitalization, doctorsâ visits, and other health care professional services. But basic Medicare doesnât cover eye exams or dental care, and youâll have to join a separate Medicare drug plan (Part D) in order to be covered for prescriptions.
Good to know
In general, Original Medicare does not cover routine or emergency health care services outside the United States. Medicare Advantage plans may offer limited coverage for emergency care abroad, depending on the plan. You may also be able to purchase a Medicare Supplement Insurance policy (Medigap) that covers emergency care in foreign countries. If you plan to spend considerable time abroad, review your planâs coverage and consider additional travel insurance if needed.
Medicare Advantage. These plans are required to cover all medically necessary services included in Original Medicare and may also offer benefits Original Medicare doesnât cover, such as vision, hearing, and dental services. Prescription drug coverage is included in most Advantage plans.
How to choose: When it comes to range of coverage, Advantage plans have the edge, but flexibility comes at a price.
The bottom line
Choosing a Medicare plan is a decision that requires careful thought, especially given the differences in costs and services. In some parts of the countryâparticularly rural areasâthe network of health care providers may be small, which could limit your options significantly.
Be sure to consider what you might pay in a typical year for expenses not covered by Original Medicare, and compare that amount to the additional insurance premiums youâd payâbeyond the $202.90 Part B premiumâto cover those gaps.
If navigating Medicare plans feels overwhelming, you can reach out to free resources such as your State Health Insurance Assistance Program (SHIP), which offers unbiased Medicare counseling. Friends and family already enrolled in Medicare can also provide valuable insights. Finally, talk to your primary care doctor and any specialists involved in your care to ensure the plan you choose supports your health needs.
