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Original Medicare vs. Medicare Advantage: A Comprehensive Comparison


As individuals enter their golden years, the role of Medicare becomes increasingly significant. This federal health insurance program is a crucial support system for Americans aged 65 and older, as well as for younger individuals with specific disabilities.

However, selecting which Medicare plan works best can be tricky. Primarily, there are two main options to consider: Original Medicare and Medicare Advantage. Choosing between these two can significantly impact your access to healthcare services, the costs you incur, and the ease with which you manage your health needs. 

For some help, below are vital considerations between Original Medicare and Medicare Advantage. We’ll explore the differences in network flexibility, prescription drug coverage, options for supplemental policies, and overall cost implications.     

Healthcare Provider Accessibility

When you shop options for Medicare, one vital thing to remember is the availability of healthcare providers, as it’s a massive part of your healthcare journey. It dictates everything, from making appointments with ease to getting good treatment.

Original Medicare

One of the most significant benefits of Original Medicare is the freedom it offers. You can choose any doctor or hospital that accepts Medicare anywhere in the United States. This flexibility mainly benefits those who travel frequently or live in multiple states yearly. 

In most cases, you do not need a referral to see a specialist, providing greater autonomy in managing your healthcare.   

Medicare Advantage

Medicare Advantage plans often have a more restricted network. You are usually required to use doctors and providers within the plan’s network for non-emergency care. While some plans offer coverage for out-of-network services, this often comes at a higher cost. Furthermore, many Medicare Advantage plans require referrals for specialist visits, which can add an extra step when it comes to managing your health. 

So before you cancel Medicare Part B, for example, to switch to Medicare Advantage, assess first whether or not this setup works for you.

Prescription Drug Coverage

One crucial aspect of any healthcare plan is its prescription drug coverage, which can profoundly impact your well-being and financial stability. For those enrolled in Medicare, grasping the intricacies of prescription drug coverage is vital, as there are notable differences between Original Medicare and Medicare Advantage plans.

Original Medicare

Original Medicare offers the option to join a separate Medicare drug plan (Part D) for prescription drug coverage, providing more personalized drug coverage tailored to your needs. However, this means you’ll have to manage an additional plan.

Medicare Advantage

Most Medicare Advantage plans include prescription drug coverage. This integration can simplify your healthcare plan by consolidating services under one provider. However, if you’re enrolled in certain types of Medicare Advantage Plans that don’t offer drug coverage, you can join a separate Medicare drug plan. 

It’s crucial to note that joining a separate Medicare drug plan while in a Medicare Advantage HMO or PPO can result in automatic disenrollment from Medicare Advantage and reversion to Original Medicare.    

Supplemental Policy Necessities

Regarding comprehensive healthcare coverage, simply relying on the basic coverage provided by Medicare plans may not be enough. Hence, it’s crucial to consider the necessity of supplemental policies to have peace of mind. 

These policies, also called Medigap, play a crucial role in managing out-of-pocket expenses, filling in any gaps in coverage, and providing financial stability for unexpected medical costs. So, don’t overlook the importance of supplemental policies regarding your healthcare needs.

Original Medicare

In healthcare, Original Medicare can come with unexpected financial burdens for beneficiaries, such as a hefty 20% coinsurance. But fear not, as there are options to help soften the financial blow, such as purchasing a Medicare Supplement Insurance (Medigap) policy. Another option that you can explore involves coverage provided by a previous employer or even Medicaid.

Medicare Advantage

Medicare Advantage comes with a different set of perks. With this option, there is no need for a Medigap policy because additional coverages are included in the plan. Plus, Medicare Advantage often has a limit on out-of-pocket expenses, providing peace of mind and eliminating the need for supplemental insurance.

Understanding the Costs

Understanding and comparing the costs of Medicare plans is crucial when choosing. The financial aspect of Medicare can be complex, presenting a maze of premiums, deductibles, and out-of-pocket expenses that must be carefully navigated.

Original Medicare

When it comes to Medicare, it’s essential to understand the potential costs under Original Medicare and Medicare Advantage plans. With Original Medicare, you’ll typically be responsible for 20% of the Medicare-approved amount for Part B-covered services after meeting your deductible. 

This percentage is known as coinsurance. If you enroll in a Medicare drug plan, you’ll also have a monthly premium for Part B and a separate premium for that coverage. One thing to keep in mind is that there’s no limit on your out-of-pocket expenses for the year unless you have additional coverage. 

Medicare Advantage

Costs under Medicare Advantage plans can vary significantly, offering a range of options to suit different budgetary needs. While enrollees are still required to pay the standard monthly Part B premium, additional costs under Medicare Advantage are influenced by several factors.

Firstly, there’s the premium for the Medicare Advantage plan itself. These premiums can vary widely depending on your chosen plan and the services it covers. 

Another significant financial consideration with Medicare Advantage plans is the cap on out-of-pocket expenses. Unlike Original Medicare, Medicare Advantage plans have an annual limit on what you pay out-of-pocket for services covered under Medicare Parts A and B. Once you reach this limit, the plan covers 100% of the covered services for the rest of the year.

Additionally, while most Medicare Advantage plans include prescription drug coverage, the costs for this coverage can also vary. It’s essential to consider the plan’s formulary and the list of covered drugs and understand how your prescriptions are covered.


The ideal option can differ for each person, considering their unique healthcare needs and financial circumstances. Hence, it is recommended to carefully evaluate current and future healthcare needs, seek guidance from healthcare experts or financial advisors if necessary, and review the details of each Medicare Advantage plan annually as offerings evolve.