Medicare Advantage vs Original Medicare: How They Differ

Doctor and hospital choice

With Original Medicare you can use any doctor or hospital that takes Medicare, anywhere in the U.S. You may pay more if your doctor does not accept assignment. In most cases you do not need a referral to see a specialist.

With Medicare Advantage you may need to use doctors and other providers in the plan's network and service area for non-emergency care. Some plans offer non-emergency coverage out of network, but it may cost more. You may need a referral to see a specialist.

What you pay each month

With Original Medicare you pay a monthly premium for Part B. If you join a Medicare drug plan, you pay a separate Part D premium.

With Medicare Advantage you pay the monthly Part B premium and may also pay the plan's premium. Some plans have a $0 premium and may help pay all or part of your Part B premium. Most plans include drug coverage, so you do not pay a separate Part D premium.

What you pay when you use care

For Part B services under Original Medicare you usually pay 20% of the Medicare-approved amount after you meet your deductible. There is no yearly limit on what you pay out of pocket, unless you have supplemental coverage such as Medigap, or other coverage such as Medicaid or employer, retiree or union coverage.

Medicare Advantage plans may have different out-of-pocket costs for certain services. Every plan has a yearly limit on what you pay for covered Medicare services. After you reach your plan's limit, you pay nothing for covered services for the rest of the year.

Medigap works with one path only

You can buy Medigap to help pay costs that Original Medicare does not, like your 20% coinsurance. You cannot buy Medigap to cover out-of-pocket costs in a Medicare Advantage plan, although you may be able to use coverage from a current or former employer or union, or Medicaid, if you have it.

Coverage, extra benefits and approvals

Original Medicare covers most medically necessary services and supplies in hospitals, doctors' offices and other health care facilities. It does not cover some services, such as routine physical exams, eye exams and most dental care. In most cases you do not need approval, called prior authorization, for Original Medicare to cover a service.

Medicare Advantage plans must cover all the medically necessary services that Original Medicare covers, and many offer extra benefits such as some vision, hearing and dental services. You may need approval from your plan before it covers certain services or supplies.

Travel outside the U.S.

Original Medicare generally does not cover medical care outside the U.S., although a Medigap policy may cover emergency care abroad. Medicare Advantage plans generally do not either, but some plans offer an extra benefit that covers emergency and urgently needed services when you travel outside the U.S.

How to decide between them

Neither path fits everyone. Start with your doctors, your prescriptions and the costs you can plan for, then compare plans in your area with Medicare's Plan Compare tool.

You can switch during the fall window, October 15 to December 7, and people already in Medicare Advantage get a second window from January 1 to March 31. Our guide to Medicare enrollment periods covers the dates.

Common questions

Does Medicare Advantage replace Original Medicare?

Medicare Advantage is an alternative to Original Medicare. You get your Part A and Part B benefits, and usually Part D, through a private plan that Medicare approved, and you still pay your Part B premium.

Can I use a Medigap policy with a Medicare Advantage plan?

No. You cannot buy Medigap to cover out-of-pocket costs in a Medicare Advantage plan.

Do I need a referral to see a specialist?

With Original Medicare you usually do not. With Medicare Advantage you may need one, depending on the plan.