Original Medicare vs. Medicare Advantage: what's the difference?
Original Medicare includes Part A and Part B, and you can use any doctor or hospital that takes Medicare. A Medicare Advantage Plan is another way to get that coverage, through a Medicare-approved plan offered by a private company. In many cases, you'll need to use health care providers who participate in the plan's network. These plans set a limit on what you'll pay out of pocket each year.
What matters most
Your choice of doctors
With Original Medicare, you can use any doctor or hospital that takes Medicare, anywhere in the U.S. With a Medicare Advantage Plan, in many cases you'll need to use health care providers who participate in the plan's network. Some plans offer non-emergency coverage out of network, but it may cost more.
A yearly limit on costs
With Original Medicare, there's no limit to what you'll pay out of pocket in a year unless you have other coverage (like Medigap or Medicaid). Medicare Advantage Plans set a limit on what you'll pay out of pocket each year for services covered under Part A and Part B. Once you reach your plan's limit, you'll pay nothing for covered services for the rest of the year.
Drug coverage and extras
With Original Medicare, you can join a separate Medicare drug plan to get Medicare drug coverage (Part D). Most Medicare Advantage Plans include Medicare drug coverage (Part D). Medicare Advantage Plans may also cover some benefits Original Medicare doesn't. These might be vision, hearing, and dental care, like check-ups or cleanings.
Want the detail? How it works, a worked example and common mix-ups are in .
Words on this page
Network
the doctors, hospitals and pharmacies a plan has agreed to work with
Prior authorization
approval you get from your plan before it will cover certain care
Medicare Advantage Plan
a Medicare-approved plan from a private company that covers your Part A and Part B benefits, and usually drug coverage (also called Part C)
Medigap
Medicare Supplement Insurance: extra insurance you can buy from a private company to help pay your share of costs in Original Medicare
Who can answer for your situation
To compare specific plans in your area, use Medicare.gov/plan-compare or call 1-800-MEDICARE (1-800-633-4227). Your State Health Insurance Assistance Program (SHIP) gives free personalized health insurance counseling and isn't connected to any insurance company or health plan.
Explains why you pick Medigap or Medicare Advantage, not both.
How each one works
When you first sign up for Medicare and during certain times of the year, you can choose which way to get your Medicare coverage. Original Medicare includes Part A and Part B. You can use any doctor or hospital that takes Medicare, anywhere in the U.S. You can join a separate Medicare drug plan to get Medicare drug coverage (Part D). You can also choose to buy Medigap to help pay your out-of-pocket costs that Medicare doesn't cover, like your 20% coinsurance.
A Medicare Advantage Plan is another way to get your Medicare Part A and Part B coverage. Medicare Advantage Plans are Medicare-approved plans offered by private companies, and they must follow rules set by Medicare. If you join one, you'll still have Medicare, but you'll get most of your Part A and Part B coverage from your plan, not Original Medicare. Most Medicare Advantage Plans include Medicare drug coverage (Part D).
What you pay
Either way, you pay a monthly Part B premium. With Original Medicare, if you choose to join a Medicare drug plan, you'll pay a separate Part D premium. With a Medicare Advantage Plan, you may also pay the plan's premium. Some plans may have a $0 premium and may help pay all or part of your Part B premium. Most plans include Medicare drug coverage (Part D), so you don't have a separate Part D premium.
With Original Medicare, you generally have to pay a portion of the cost for each service it covers. There's no limit to what you'll pay out of pocket in a year unless you have other coverage (like Medigap, Medicaid, employer, retiree, or union coverage). Medicare Advantage Plans set a limit on what you'll pay out of pocket each year for services covered under Part A and Part B. Once you reach your plan's limit, you'll pay nothing for covered services for the rest of the year.
What's covered, and what needs approval
Original Medicare covers most medically necessary services and supplies in hospitals, doctors' offices, and other health care facilities. It doesn't cover some services, like routine physical exams, eye exams, and most dental care. Medicare Advantage Plans provide almost all medically necessary services and supplies Original Medicare covers, and may cover some benefits Original Medicare doesn't. These benefits are generally limited, so check with the plan before you join to find out what exactly is covered.
If you have Original Medicare, you don't need a referral to use a specialist in most cases, and you generally don't need prior approval to use a covered benefit. With a Medicare Advantage Plan, for certain services or drugs, you may need approval (also called prior authorization) from your plan before it covers them. In some cases, you may also need a referral to use a specialist.
An example
Say you see specialists in two different cities. With Original Medicare, you can use any doctor or hospital that takes Medicare, anywhere in the U.S., and you don't need a referral to use a specialist in most cases. With a Medicare Advantage Plan, in many cases you'll need to use health care providers who participate in the plan's network, and in some cases you may also need a referral to use a specialist.
Common mix-ups
These are the pairs people most often mix up.
They're both Medicare
If you join a Medicare Advantage Plan, you'll still have Medicare. You'll get most of your Part A and Part B coverage from your plan, not Original Medicare. Medicare Advantage Plans are Medicare-approved plans offered by private companies, and they must follow rules set by Medicare.
A $0 premium plan and the Part B premium
Some Medicare Advantage Plans may have a $0 premium. In a Medicare Advantage Plan, you pay a monthly Part B premium and may also pay the plan's premium. Some plans may help pay all or part of your Part B premium.
Medigap goes with Original Medicare
With Original Medicare, you can choose to buy Medigap to help pay your out-of-pocket costs that Medicare doesn't cover. You can't buy Medigap while you're in a Medicare Advantage Plan, unless you're switching back to Original Medicare.
Open Enrollment happens from October 15 to December 7 and is the time each year when you can make changes to your coverage. The changes you make are effective January 1 of next year. In most cases, if you join a Medicare Advantage Plan, you must keep it for the calendar year. If you're already in one, you can make one change from January 1 to March 31.
The web shows only the closest connections, so it stays a guide rather than a maze.
Can I trust this?
Checked by TapTap. Every fact on this page was checked against the official sources it quotes, on October 1, 2026.
Checking compares each fact with the official source it quotes. It isn’t medical or legal advice.
When you first sign up for Medicare and during certain times of the year, you can choose which way to get your Medicare coverage. There are 2 main ways:
Checked October 1, 2026
2 What the source says · Your Medicare options
Original Medicare includes Part A and Part B. You can use any doctor or hospital that takes Medicare. You can join a separate Medicare drug plan to get Medicare drug coverage (Part D).
3 What the source says · Doctor & hospital choice (Original Medicare)
You can use any doctor or hospital that takes Medicare, anywhere in the U.S.
Checked October 1, 2026
8 What the source says · Cost (Medicare Advantage)
Plans have a yearly limit on what you pay for covered Medicare services (which may include different limits for in-network and out-of-network services). Once you reach your plan's limit, you'll pay nothing for covered services for the rest of the year.
Checked October 1, 2026
11 What the source says · Coverage (Original Medicare)
Original Medicare covers most medically necessary services and supplies in hospitals, doctors' offices, and other health care facilities. Original Medicare doesn't cover some services, like routine physical exams, eye exams, and most dental care.
Checked October 1, 2026
16 What the source says · Cost (Original Medicare)
You can choose to buy Medigap to help pay your out-of-pocket costs that Medicare doesn't cover (like your 20% coinsurance).
4 What the source says · Section 3: Original Medicare, How does Original Medicare work? (p. 61)
You generally have to pay a portion of the cost for each service Original Medicare covers. There's no limit to what you'll pay out of pocket in a year unless you have other coverage (like Medigap, Medicaid, employer, retiree, or union coverage).
Checked October 1, 2026
5 What the source says · Section 4: Medicare Advantage Plans & other options, What are Medicare Advantage Plans? (p. 65)
A Medicare Advantage Plan is another way to get your Medicare Part A and Part B coverage. Medicare Advantage Plans are Medicare-approved plans offered by private companies and must follow rules set by Medicare.
Checked October 1, 2026
6 What the source says · Section 4: Medicare Advantage Plans & other options, What are Medicare Advantage Plans? (p. 65)
Most Medicare Advantage Plans include Medicare drug coverage (Part D). In many cases, you'll need to use health care providers who participate in the plan's network. These plans set a limit on what you'll pay out of pocket each year for services covered under Part A and Part B. Some plans offer non-emergency coverage out of network, but it may cost more. For certain services or drugs, you may need approval (also called prior authorization) from your plan before it covers them. In some cases, you may also need a referral to use a specialist.
Checked October 1, 2026
7 What the source says · Section 4: Medicare Advantage Plans & other options, What are Medicare Advantage Plans? (p. 65)
If you join a Medicare Advantage Plan, you'll still have Medicare but you'll get most of your Part A and Part B coverage from your plan, not Original Medicare.
Checked October 1, 2026
9 What the source says · Section 4: Medicare Advantage Plans & other options, Plans may offer some extra benefits (p. 66)
Medicare Advantage Plans may cover some benefits Original Medicare doesn't. These might be certain gym memberships or discounts, vision, hearing, and dental care, like check-ups or cleanings.
Checked October 1, 2026
10 What the source says · Section 4: Medicare Advantage Plans & other options, Plans may offer some extra benefits (p. 66)
These benefits are generally limited, so check with the plan before you join to find out what exactly is covered and if these benefits are available to you.
Checked October 1, 2026
12 What the source says · Section 4: Medicare Advantage Plans & other options, What do Medicare Advantage Plans cover? (p. 65)
Medicare Advantage Plans provide almost all medically necessary services and supplies Original Medicare covers.
Checked October 1, 2026
13 What the source says · Section 4: Medicare Advantage Plans & other options (p. 67)
Compare: If you have Original Medicare, you don't need a referral to use a specialist in most cases (page 61), and you generally don't need prior approval to use a covered benefit.
Checked October 1, 2026
14 What the source says · At a glance comparison, Cost, Original Medicare column (p. 11)
You pay a monthly Part B premium. If you choose to join a Medicare drug plan to get Medicare drug coverage (Part D), you'll pay a separate Part D premium.
Checked October 1, 2026
15 What the source says · At a glance comparison, Cost, Medicare Advantage column (p. 11)
You pay a monthly Part B premium and may also pay the plan's premium. Some plans may have a $0 premium and may help pay all or part of your Part B premium. Most plans include Medicare drug coverage (Part D), so you don't have a separate Part D premium.
Checked October 1, 2026
17 What the source says · Section 4: Medicare Advantage Plans & other options, What if I have Medicare Supplement Insurance (Medigap)? (p. 68)
You can't buy Medigap while you're in a Medicare Advantage Plan, unless you're switching back to Original Medicare.
Checked October 1, 2026
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General education, not individualized advice. For your own situation, you can call 1-800-MEDICARE or your State Health Insurance Assistance Program (SHIP).
