Original Medicare vs. Medicare Advantage: What’s the Difference?
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Original Medicare and Medicare Advantage are two different ways to receive Medicare coverage. Both provide Medicare Part A and Part B benefits, but they can differ significantly in how coverage is delivered, which providers you can use, how prescription drugs are covered and what you may pay for care.
Quick answer: Original Medicare is administered by the federal government and generally allows you to use any doctor or hospital in the United States that accepts Medicare. Medicare Advantage, also called Part C, provides your Medicare benefits through a Medicare-approved private insurance company and may use provider networks and other plan rules.
For a broader overview of Medicare coverage, costs, plan options and enrollment, see our complete guide to Medicare in California.
What Is Original Medicare?
Original Medicare is the traditional federal Medicare program.
It consists of:
- Medicare Part A: Hospital Insurance
- Medicare Part B: Medical Insurance
Part A primarily helps cover qualifying inpatient hospital care, skilled nursing facility care, hospice care and certain home health services.
Part B helps cover doctors, outpatient care, preventive services, durable medical equipment and other covered medical services.
Learn more in our guide to Medicare Part A vs. Part B.
What Is Medicare Advantage?
Medicare Advantage is also known as Medicare Part C.
It is an alternative way to receive your Medicare Part A and Part B benefits through a private insurance company that contracts with Medicare.
You must generally have both Medicare Part A and Part B to join a Medicare Advantage plan and continue paying your Part B premium while enrolled.
Medicare Advantage plans must cover the medically necessary services that Original Medicare covers, but plans can have different rules, provider networks and cost-sharing.
Most Medicare Advantage plans also include Medicare Part D prescription drug coverage.
Original Medicare vs. Medicare Advantage at a Glance
| Original Medicare | Medicare Advantage |
|---|---|
| Administered by the federal government | Offered by private insurance companies that contract with Medicare |
| Includes Part A and Part B | Provides Part A and Part B benefits |
| Generally allows any provider in the U.S. that accepts Medicare | May use a provider network and service area |
| Most outpatient prescription drugs require a separate Part D plan | Most plans include Part D prescription drug coverage |
| Medigap may be available to help with certain out-of-pocket costs | Medigap cannot be used to cover Medicare Advantage cost-sharing |
| No annual out-of-pocket maximum for Part A and Part B services | Plans have an annual limit on out-of-pocket costs for covered Part A and Part B services |
Can You Use Any Doctor With Original Medicare?
With Original Medicare, you can generally use any doctor or hospital in the United States that accepts Medicare.
In most cases, you do not need to choose a primary care doctor, and Original Medicare generally does not require referrals to see specialists.
However, you should still confirm that a provider accepts Medicare before receiving care.
Does Medicare Advantage Have Provider Networks?
Medicare Advantage plans may use provider networks.
Depending on the type of plan, receiving care outside the plan's network may cost more or may not be covered except in certain situations such as emergencies.
Some plans may also require referrals or prior authorization for certain services.
Because provider participation can change, it is important to review the current plan network when evaluating Medicare Advantage coverage.
How Does Prescription Drug Coverage Differ?
Original Medicare does not cover most outpatient prescription drugs.
People with Original Medicare who want prescription drug coverage can generally enroll in a separate Medicare Part D plan.
Most Medicare Advantage plans include Part D prescription drug coverage within the plan. These are often referred to as Medicare Advantage Prescription Drug plans.
Drug formularies, pharmacy networks and prescription costs can vary by plan.
Learn more in our guide to Medicare Part D and prescription drug coverage.
How Do Costs Differ?
Costs can work differently under Original Medicare and Medicare Advantage.
With Original Medicare, you may be responsible for applicable Part A and Part B premiums, deductibles and coinsurance. For many Part B services, beneficiaries generally pay 20% of the Medicare-approved amount after meeting the Part B deductible when the provider accepts assignment.
Original Medicare does not have an annual out-of-pocket maximum for covered Part A and Part B services.
Medicare Advantage plans set their own cost-sharing within Medicare rules. Depending on the plan and service, you may pay deductibles, copayments or coinsurance.
Medicare Advantage plans have an annual limit on what you pay out of pocket for covered Part A and Part B services. After reaching the applicable limit, the plan pays the covered Part A and Part B costs for the remainder of the year according to Medicare rules.
Do Medicare Advantage Plans Have a $0 Premium?
Some Medicare Advantage plans may have a $0 additional monthly plan premium.
A $0 plan premium does not mean that Medicare or health care is free.
You generally must continue paying your Medicare Part B premium, and the plan can still have deductibles, copayments, coinsurance and other out-of-pocket costs.
Premiums and plan availability vary by location and can change from year to year.
Does Medicare Advantage Include Extra Benefits?
Medicare Advantage plans may offer additional benefits that Original Medicare does not cover.
Depending on the plan, these may include certain:
- Dental benefits
- Vision benefits
- Hearing benefits
- Fitness or wellness benefits
Additional benefits vary by plan and may have coverage limits, provider requirements or other restrictions.
These benefits should be reviewed alongside the plan's medical coverage, provider network, prescription coverage and overall costs.
Can You Buy Medigap With Original Medicare?
If you have Original Medicare and meet the applicable eligibility requirements, you may be able to purchase Medicare Supplement Insurance, commonly called Medigap.
Medigap policies are designed to help pay certain out-of-pocket costs left by Original Medicare.
Medigap is separate from Medicare Advantage.
You cannot use a Medigap policy to pay Medicare Advantage deductibles, copayments or coinsurance.
See our guide to Medicare Advantage vs. Medicare Supplement (Medigap) to understand the difference.
What About Coverage While Traveling?
Original Medicare generally allows you to receive covered care from Medicare-participating providers throughout the United States.
Medicare Advantage plans generally have defined service areas and may use provider networks.
Emergency and urgently needed care have specific protections, but routine non-emergency coverage outside a Medicare Advantage plan's network or service area can depend on the plan.
If you regularly spend time in different states or travel frequently, reviewing how a plan handles care away from home can be important.
Does Original Medicare Require Prior Authorization?
Original Medicare generally does not use prior authorization in the same way many Medicare Advantage plans do, although Medicare has prior authorization requirements for certain services and items.
Medicare Advantage plans may require prior authorization for certain covered services according to Medicare rules and the plan's requirements.
Plan rules can vary, so beneficiaries should review the current plan documents for details.
Can You Switch Between Original Medicare and Medicare Advantage?
Medicare provides certain enrollment periods when eligible beneficiaries can make changes to their coverage.
During Medicare Open Enrollment, which runs each year from October 15 through December 7, beneficiaries can make certain changes between Original Medicare, Medicare Advantage and Medicare prescription drug coverage for the following year.
There is also a Medicare Advantage Open Enrollment Period from January 1 through March 31 for people who are already enrolled in a Medicare Advantage plan. Different rules apply during this period.
Special Enrollment Periods may also be available in certain circumstances.
See our guide to Medicare Open Enrollment 2027 for more information about annual enrollment dates and changes.
Can You Always Buy Medigap if You Leave Medicare Advantage?
No. The ability to purchase a Medigap policy after leaving Medicare Advantage can depend on your circumstances, timing and applicable federal or state protections.
Medigap has its own enrollment rules that are separate from Medicare Advantage enrollment periods.
Your federal Medigap Open Enrollment Period generally lasts six months and begins when you are age 65 or older and enrolled in Medicare Part B.
Outside protected enrollment situations, your ability to purchase a Medigap policy and the rules that apply can differ.
Because of this, someone considering a change from Medicare Advantage to Original Medicare should understand the Medigap rules that apply to their situation before assuming a Medigap policy will be available.
Which Type of Medicare Coverage Should You Review?
Original Medicare and Medicare Advantage structure coverage differently, so comparing them involves more than looking at a monthly premium.
Important factors to understand include:
- Doctors and hospitals you use
- Provider networks
- Prescription medications
- Monthly premiums
- Deductibles, copayments and coinsurance
- Annual out-of-pocket exposure
- Prior authorization and referral requirements
- Coverage when traveling
- Additional benefits offered by a plan
These factors can affect people differently depending on their health care needs and circumstances.
Frequently Asked Questions
Is Medicare Advantage the same as Medicare Part C?
Yes. Medicare Advantage is also called Medicare Part C. It is an alternative way to receive Medicare Part A and Part B benefits through a private insurance company that contracts with Medicare.
Do you still have Medicare if you choose Medicare Advantage?
Yes. Medicare Advantage is part of the Medicare program. You remain enrolled in Medicare and generally must have both Part A and Part B to join a Medicare Advantage plan.
Do you still pay the Part B premium with Medicare Advantage?
Yes. You generally continue paying the Medicare Part B premium while enrolled in Medicare Advantage. Some plans may charge an additional plan premium.
Does Original Medicare include prescription drug coverage?
Original Medicare does not include most outpatient prescription drug coverage. Beneficiaries can generally add a separate Medicare Part D plan.
Does Medicare Advantage include prescription drug coverage?
Most Medicare Advantage plans include Part D prescription drug coverage, although plan designs vary.
Does Original Medicare have an annual out-of-pocket maximum?
No. Original Medicare does not have an annual out-of-pocket maximum for covered Part A and Part B services.
Does Medicare Advantage have an annual out-of-pocket limit?
Yes. Medicare Advantage plans have an annual limit on out-of-pocket costs for covered Part A and Part B services. The specific limit can vary by plan within Medicare requirements.
Can Medigap be used with Medicare Advantage?
No. Medigap is designed to supplement Original Medicare and cannot be used to pay Medicare Advantage plan cost-sharing.
This article is for general educational and informational purposes. Medicare coverage, costs, provider networks, benefits, enrollment rules and plan availability can vary based on individual circumstances, location and plan, and may change over time. For official Medicare information, visit Medicare.gov or call 1-800-MEDICARE.