Medicare vs. Medicare Advantage: Key Differences, Costs, and How to Choose

Weighing whether to choose the original Medicare or a Medicare Advantage plan? “A lot of people will just go with what their friends have,” says Medicare expert Lauren Bigham Steele—but this can create problems. Here’s what people who have reached or soon will reach age 65 need to know to make the critical Medicare Advantage vs. original Medicare choice.

What Is Original Medicare?

Original Medicare, sometimes called “traditional Medicare,” is what most people picture when they imagine Medicare. It’s a federal government-run healthcare program that includes:

• Medicare Part A: which covers inpatient hospital stays, skilled nursing care, hospice care, and certain other services
• Medicare Part B: which covers doctor’s appointments, preventive care, lab tests, and certain other outpatient services

Many original Medicare enrollees purchase a Medicare Part D prescription drug plan, too, and a Medicare Supplement plan—also known as Medigap (more on this below).

What Is Medicare Advantage?

Medicare Advantage, also known as Medicare Part C, offers an alternative to the government-run original Medicare system.

Part C plans are provided by private insurance companies, not the federal government, but by law these plans must cover all services offered by original Medicare Part A and Part B.

Most Medicare Advantage plans include prescription drug coverage, and many also offer benefits beyond those provided by original Medicare, often including some dental, vision, and hearing care, all of which are potentially valuable perks for people making the Medicare Part C vs original Medicare choice.

Medicare vs. Medicare Advantage: Key Differences

Most people comparing Medicare coverage are really deciding among three common approaches. The chart below summarizes the biggest differences, followed by a closer look at each one.

Coverage Options at a Glance

Here’s how these factors play out in practice:

Access to Doctors and Hospitals

With a Medicare Advantage plan, healthcare bills are likely to be well covered only when services are provided by doctors or hospitals that are in the plan’s network—it’s a lot like being in an HMO or PPO health insurance plan.

Medicare Advantage networks are typically regional, so these plans can create challenges for people who travel frequently or split their year between different parts of the country.

Original Medicare does not have restrictive provider networks—enrollees can obtain care from any healthcare provider or hospital that accepts Medicare, something virtually all US doctors and hospitals do. However, note that not all doctors who participate accept new patients.

Costs

Comparing Medicare costs isn’t as simple as comparing monthly premiums. Everyone enrolled in Medicare pays the standard Part B premium, whether they choose original Medicare or Medicare Advantage.

The biggest cost differences come from supplemental premiums, deductibles, copays, provider networks, and out-of-pocket limits. More on this below.

Higher-income beneficiaries may also pay an Income-Related Monthly Adjustment Amount (IRMAA), an additional surcharge based on income from two years earlier—a detail worth weighing for people still working who are comparing Medicare against employer-sponsored coverage, since leaving a plan with high deductibles isn’t always the most cost-effective option.

Prescription Drug Coverage

Original Medicare doesn’t automatically include prescription drug coverage, so most beneficiaries who choose it also enroll in a standalone Medicare Part D plan.

By contrast, Medicare Advantage plans usually include drug coverage at no additional cost, for example, while original Medicare enrollees often pay to obtain this, with premiums generally falling somewhere between $25 and $75 per month.

The trade-off is flexibility. Original Medicare enrollees with a Part D plan can select the drug coverage that best fits their prescription needs, while Medicare Advantage plans usually bundle a specific drug plan with their other coverage, limiting choice.

Extra Benefits

Medicare Advantage plans often include benefits that aren’t covered by original Medicare, such as routine dental, vision, and hearing care.

For people who choose original Medicare with Medigap, some Medigap insurers offer value-added wellness programs or fitness benefits, but these extras vary by carrier and aren’t part of standardized Medigap coverage.

Sometimes Medicare Advantage perks are modest, perhaps covering the cost of a dental cleaning or pair of eyeglasses, but other plans provide significant coverage for these healthcare needs. “In some counties you can get Advantage plans that provide up to $3,000 for dental coverage,” says Bigham Steele. “And some plans offer new hearing aids every other year.”

Medicare Advantage plans from insurers such as UnitedHealthcare, Humana, Aetna, and Blue Cross Blue Shield affiliates often offer additional perks, including gym memberships, transportation to medical appointments, and meal delivery following hospital stays. Benefits vary by insurer, plan, and location, and some plans have scaled back these offerings in recent years.

Prior Authorization and Referrals

Medicare Advantage plans often require enrollees to obtain referrals and/or preapproval before obtaining specialized care. Original Medicare only very rarely forces enrollees to clear such hurdles.

Exception: A pilot program named Wastefulness and Inappropriate Services Reduction (WISeR) adds an extra check for a short list of non-emergency medical procedures that are frequently provided unnecessarily. In six states—New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington—providers treating original Medicare enrollees will need to either secure prior authorization before performing one of these procedures or submit to a review after the fact but before Medicare pays out.

Which Plan Gives You More Flexibility?

Original Medicare is the flexibility winner—it gives enrollees the right to obtain care from virtually any US healthcare provider, almost always without any need to first obtain referrals or prior authorizations. “On original Medicare you can see anyone,” says Bigham Steele, “as long as they take Medicare.”

But before you make your final decision, it’s worth noting that some Medicare Advantage plans are more flexible than others, notes Bigham Steele.

HMO Medicare Advantage plans won’t cover out-of-network doctors or hospitals in most circumstances, but PPO Medicare Advantage plans often will cover virtually any doctor or hospital that accepts Medicare—though enrollees do face higher out-of-pocket costs when they see out-of-network providers.

How Costs Compare

To see how costs compare in practice, consider a hypothetical 65-year-old Ohio man who is deciding which type of Medicare coverage to choose in 2026. The chart below uses 2026 national Medicare figures and Ohio average Medigap premiums to illustrate the differences.

Medicare Advantage premiums vary by county, so the figures shown are national averages. Actual plan costs and provider networks depend on where you live, and you can compare plans available in your area using Medicare Plan Finder.

This example assumes the individual has worked at least 40 quarters, making Medicare Part A premium-free under any of the three coverage options.

Monthly Premiums

Ads for Medicare Advantage plans often trumpet their $0 cost, and most of these plans do indeed impose very low monthly premiums or have no monthly premiums at all. “There are some I’ve seen that are like $30ish,” says Bigham Steele, “but most are $0 to $15 a month.”

But a Medicare Advantage plan with a $0 premium doesn’t actually provide free coverage—everyone pays Medicare’s Part B premium, which as of 2026 is $202.90 per month for most enrollees. Note that high earners pay increased rates due to IRMAA.

Medigap Changes the Math

The big difference in premiums comes when original Medicare enrollees add a Medigap plan. Medigap plans fill many of original Medicare’s daunting coverage gaps, but they do so for a price. That combination raises monthly premiums but greatly reduces unexpected bills.

The popular Medigap Plan G can cost anywhere from around $100 per month to more than $400 per month, depending on factors including age and state. Medicare Advantage enrollees don’t need Medigap plans.

Co-pays vs. Coinsurance

Premiums are only one piece of the puzzle. Medicare Advantage enrollees typically pay a predictable, pre-set co-pay when they see an in-network doctor—maybe $10 or $20 for a primary care visit, or $30 to $50 for a specialist.

Original Medicare enrollees without Medigap instead pay 20% of the Medicare-approved cost of the visit, after meeting Part B’s $283 annual deductible.

Similar out-of-pocket costs apply to many other healthcare services as well, with Medicare Advantage enrollees generally paying flat co-pays for ER visits, urgent care visits, in-network medical imaging, and more, while original Medicare enrollees who lack Medigap plans usually pay 20% of the Medicare approved amount for such things.

With the high cost of US healthcare, that 20% could add up to retirement-ruining bills, something extremely unlikely for a Medicare Advantage enrollee who obtains care in-network.

Out-of-Pocket Maximums

This is where the real risk shows up. With Medicare Advantage plans, the maximum annual out-of-pocket cost for in-network care is currently $9,250, and many plans set this figure substantially lower.

But with original Medicare and no Medigap plan, there’s no out-of-pocket maximum. “If you just have original Medicare, you have that 20% out of pocket that you could be liable for,” says Bigham Steele. “That could easily blow way past the $9,250 out-of-pocket max of a Medicare Advantage plan.”

This potential for massive out-of-pocket medical bills is why many people who enroll in original Medicare also enroll in a Medigap plan.

Sign up for the popular Medigap G Plan, for example, and the only out-of-pocket cost you’re likely to face for medically necessary healthcare services is the $283 annual Part B deductible.

“If you have Plan G, you’re only paying that $283 deductible,” says Bigham Steele. “There’s nothing else out of pocket for the entire year. If you’ve already paid that deductible and you have a $100,000 surgery, the surgery will have no out-of-pocket costs.”

How to Choose Between Original Medicare and Medicare Advantage

Is original Medicare or Medicare Advantage the better choice? Americans are divided almost evenly on that topic, with 55% picking Advantage in 2026, according to health policy organization KFF.

The better question is which is better for you based on your priorities:

Can You Switch Later?

You can switch between original Medicare and Medicare Advantage during certain enrollment periods, but what you can do—and when your new coverage begins—depends on which enrollment period applies.

Note that…

• You cannot switch from original Medicare to Medicare Advantage during this MAOEP window.
• If you switch from Medicare Advantage to original Medicare after your Initial Enrollment Period (IEP), which concludes at the end of the third month following the month of your 65^thbirthday, you might have to pass medical underwriting to obtain a Medigap plan, with certain exceptions.