What’s the Difference Between Original Medicare vs Medicare Advantage?

Fact Checked by Elaine Wong Eakin | Updated on September 10, 2025
In This Article
Find Medicare Plans With Extra Benefits Not in Original Medicare

Explore Medicare Advantage or Medicare Supplement Plans

Michael LaPick

Written by Michael LaPick

Healthcare Writer

Elaine Wong Eakin

Reviewed by Elaine Wong Eakin

We aim to help you make informed healthcare decisions. While this post may contain links to lead generation forms, this won’t influence our writing. We follow strict editorial standards to give you the most accurate and unbiased information.

Comparing Original Medicare vs Medicare Advantage

Most older adults and those with certain disabilities enroll in Original Medicare, which includes Part A (hospital insurance) and Part B (medical insurance). Original Medicare lets you visit any doctor or hospital in the U.S. that accepts Medicare but often comes with high out-of-pocket costs and may not cover medications.

To manage these costs, many people add supplements to Original Medicare or opt for Medicare Advantage (Part C), which replaces Parts A and B, offering similar services but functioning like independent health insurance.

What is Original Medicare?

Original Medicare consists of Part A and Part B.

Medicare Part A covers:

  • Hospital stays and care
  • Skilled nursing facilities (subject to criteria)
  • Hospice care
  • Home health care not related to hospice

Medicare Part B covers:

  • Doctor visits and preventive care
  • Medical equipment
  • Lab tests
  • Same-day surgery
  • Counseling and therapy sessions
  • Ambulance services

However, Parts A and B don’t cover eye exams for glasses, most dental care, dentures, cosmetic surgery, acupuncture, hearing aids, or outpatient prescription drugs.

What is Medicare Advantage (Part C)?

Medicare Advantage plans, sold by independent insurers, replace Part A and Part B but include all their services and often additional benefits such as:

  • Routine vision
  • Routine hearing
  • Dental coverage

They may also include prescription drug coverage.

Costs and Coverage

Original Medicare can be costly without supplemental coverage. Medicare Advantage plans have an annual out-of-pocket maximum of $8,850, capping costs for covered services.

Types of Medicare Advantage plans:

  • Health Maintenance Organizations (HMOs): Require choosing a primary care doctor and referrals for specialists.
  • Preferred Provider Organizations (PPOs): Allow seeing any Medicare-accepting provider but offer lower costs for in-network services without needing referrals.

Comparing Original Medicare vs Medicare Advantage

  • Providers: Original Medicare allows seeing any Medicare-accepting doctor or hospital in the U.S., while Medicare Advantage may restrict you to a network.
  • Service Area: Original Medicare is limited to the U.S. Medicare Advantage networks can be restrictive if you live in multiple locations.
  • Cost: Original Medicare has no cap on out-of-pocket expenses, while Medicare Advantage caps them at $8,850 annually.
  • Referrals: Original Medicare doesn’t require referrals for specialists; some Medicare Advantage plans do.
  • Benefits: Medicare Advantage may offer additional benefits not covered by Original Medicare, like dental and vision.
  • Prescription Drugs: Original Medicare doesn’t cover outpatient prescription drugs without a Part D supplement. Many Medicare Advantage plans include drug coverage.

Conclusion

Weighing the pros and cons of Original Medicare vs Medicare Advantage is essential for making the best decision for your healthcare needs and financial situation. Remember, you can switch plans during open enrollment periods.

Article Sources

Michael LaPick
About the author

Michael LaPick

Healthcare Writer

Michael LaPick is a healthcare and Medicare data researcher at HealthCare.com, where he develops educational resources for HealthcareInsider.com and MedicareGuide.com. He has over five years of specialized experience researching Medicare, the Affordable Care Act (ACA), and private health insurance, helping consumers make confident, informed coverage decisions.

His work draws on a background in investigative journalism, having reported for the Poughkeepsie Journal and WAMC/NPR Albany on how Americans spend and manage money. This blend of investigative rigor and healthcare expertise gives Michael a unique perspective in translating complex policy data into actionable guidance for readers.

Michael’s research and articles are widely cited across healthcare publications, strengthening his role as a trusted authority in the insurance space.


Search

Get matched with a Medicare plan that fits your needs!

Explore coverage options