How to Choose the Right Fit for You
Choosing a Medicare plan can feel overwhelming. You’ve probably heard about Original Medicare and Medicare Advantage Plans, but what’s the real difference? Both options will give you health coverage—it just depends on your lifestyle, budget, and priorities. Let’s walk through the main things to consider so you can feel more confident in your choice.
Doctor & Hospital Choice
One of the biggest differences comes down to where you can get care.
- Original Medicare gives you the most flexibility. You can see any doctor or hospital anywhere in the U.S., as long as they accept Medicare. And in most cases, you don’t need a referral to visit a specialist. It’s a great option if you travel often or just like having freedom to choose.
- Medicare Advantage, on the other hand, usually works more like traditional insurance plans. You’ll likely need to use doctors and hospitals that are in your plan’s network and service area, except for emergencies. Some plans also ask for a referral before you can see a specialist.
👉 If you want nationwide access to doctors and hospitals, Original Medicare gives you more freedom. If you don’t mind staying in-network, Medicare Advantage may work fine.
Costs
How much you pay can also look different depending on which option you choose.
- With Original Medicare, you pay the standard Part B premium each month. For most services, you’ll also pay 20% of the Medicare-approved cost once you meet your deductible. If you want prescription drug coverage, you’ll need to sign up for a separate Part D plan, which adds another premium. One big thing to keep in mind: there’s no yearly limit on how much you might spend out-of-pocket—unless you have extra coverage, like a Medigap (Medicare Supplement) policy.
- With Medicare Advantage, you still pay your Part B premium, but many plans also have their own premium (some even $0). Most Advantage plans include Part D prescription coverage at no extra cost. One of the biggest perks is that they come with an annual out-of-pocket limit. Once you hit that cap, you don’t pay anything more for covered services for the rest of the year.
👉 If a spending cap and bundled drug coverage sound appealing, Medicare Advantage may be a better deal. If you’d rather keep things straightforward and add coverage as you need it, Original Medicare might fit you best.
Coverage
Both options cover medically necessary care, but there are some differences.
- Original Medicare covers most hospital and medical services but doesn’t pay for things like routine dental, vision, or hearing. You generally don’t need prior approval for medical care, you’ll need to buy a separate Medicare Part D plan for prescription drugs.
- Medicare Advantage plans are required to cover everything Original Medicare does, but they can have their own rules, like requiring prior authorization before you get certain services. Many Advantage plans include extra benefits, like dental, vision, hearing aids, wellness programs, and sometimes even gym memberships. Plus, most already include Part D drug coverage.
👉 If you like the idea of extra perks bundled with your coverage, Medicare Advantage might have the edge. If you’d rather keep coverage simple and build on it with a Medigap (Medicare Supplement), Original Medicare could be a better match.
Putting It All Together
Here’s a simple way to think about it:
- Original Medicare = Flexibility.
You can see almost any doctor nationwide, and you can customize your coverage with Medigap (Medicare Supplement) and Medicare Part D if you want extra protection. - Medicare Advantage = All in One Plan.
You get an all-in-one plan with drug coverage and extra benefits, plus peace of mind from a yearly spending limit—but you’ll need to within the plan’s network.
Your health coverage is very important. Our goal is to assist you in making the best decision for your health care needs. We will explain ALL of your coverage options and help you in understanding what each options means to you and your healthcare.
