What’s the difference between Original Medicare and Medicare Advantage?

The federal government administers Original Medicare, while private insurance companies that contract with Medicare provide Medicare Advantage plans. These plans often include additional benefits, like prescription drugs, dental, and vision coverage.

What are the disadvantages of a Medicare Advantage plan?

Medicare Advantage plans require you to see healthcare providers within their specific provider networks. They also have the potential for higher out-of-pocket costs and regional limitations that could affect your coverage when you travel.

Can you switch from traditional Medicare to Medicare Advantage?

Yes. You can switch during the annual enrollment period, which runs from Oct. 15 to Dec. 7 each year, or during the Medicare Advantage open enrollment period, which runs from Jan. 1 through March 31 each year.

Why do people choose Medicare Advantage?

People choose Medicare Advantage plans when they want more comprehensive coverage than Original Medicare provides or a cap on out-of-pocket costs under Medicare Parts A and B.

What Is a Medicare Advantage Health Insurance Plan?

Medicare Advantage
MA vs. Original Medicare
Pros and cons
How to enroll
FAQs

Medicare Advantage
MA vs. Original Medicare
Pros and cons
How to enroll
FAQs

A Medicare Advantage health insurance plan, also known as Medicare Part C, is a private alternative to Original Medicare. Unlike Original Medicare, which is government-run and includes Part A (hospital insurance) and Part B (medical insurance), Medicare Advantage plans bundle additional benefits like prescription drug coverage and dental and vision care.

Original Medicare might be your best option if you want a straightforward, cost-effective plan with a broad choice of healthcare providers. Medicare Advantage (MA) might be a better fit if you want extra benefits and are comfortable with network restrictions.

Here’s what you should know about Medicare Advantage plans, how they work, and the enrollment process.

What is Medicare Advantage?

Medicare Advantage is a type of health insurance plan that private insurers offer. These insurers contract with Medicare to provide all your Part A and Part B benefits, plus some additional coverages that Original Medicare doesn’t have.^[1]

Part A covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home healthcare.
Part B covers certain doctor’s services, outpatient care, medical supplies, and preventive services.
Depending on your plan, Part C (Medicare Advantage) typically includes prescription drug coverage (also known as Medicare Part D) and may also offer dental, vision, hearing care, wellness programs, and other benefits.

Good to Know

To enroll in a Medicare Advantage plan, you must first enroll in Original Medicare and then switch to the MA plan of your choice.

Differences between MA plans and Original Medicare

MA plans and Original Medicare offer different ways to receive your Medicare benefits. The table below provides a detailed comparison.

Feature	Original Medicare	Medicare Advantage
Coverage	Includes Part A (hospital) and Part B (medical).	Includes Part A and Part B, often includes Part D (prescription drugs), dental, vision, and hearing.
Cost	You’ll pay standard premiums, deductibles, and 20% co-insurance.	Cost varies by plan and may include additional premiums, copayments, and out-of-pocket limits.
Provider choice	You can see any Medicare-approved doctor or hospital in the United States.	Typically, you must choose from a specific network of providers.
Out-of-pocket limits	Original Medicare has no annual limit on the amount you’ll have to pay out of pocket.	Your annual out-of-pocket medical and hospital expenses are capped at a specific limit.
Prescription drug coverage	You’ll also need to get separate Part D Medicare drug coverage.	Most plans include prescription drug coverage.
Additional benefits	Limited, requires a separate policy.	Often includes dental, vision, hearing, and wellness programs, such as a gym membership.
Coverage area	Limited to the U.S., although you may be able to buy a Medicare Supplement Insurance (Medigap) policy to cover emergency care while traveling outside the U.S.	Usually limited to a specific geographic area. Some plans allow you to purchase supplemental coverage for emergency medical services when traveling.

Medicare Advantage plans aren’t the right choice for everyone. Before purchasing an MA plan, consider the following:

Do you want to keep your current doctors, or are you comfortable choosing from a network? Several types of Medicare Advantage plans are available. Some are health maintenance organizations (HMOs) or preferred provider organizations (PPOs), meaning you have to visit an in-network healthcare provider.
Will you need coverage while traveling outside your plan’s service area?
Do you require extended coverage, like dental, vision, or hearing benefits?
Do you want to limit your out-of-pocket expenses?
Do you have a specific health condition? If so, you may want a Special Needs Plan (SNP). These Medicare Advantage plans provide services for people with specific healthcare needs, like cancer or congestive heart failure.

Learn More: The Difference Between Medicare and Medicaid Explained

Pros and cons of Medicare Advantage plans

While MA health plans offer many benefits, they also have limitations that could affect your enrollment decision. Here are some pros and cons to consider.

Pros

Comprehensive coverage: MA plans often bundle additional benefits, like prescription drug coverage, dental care, vision, and hearing, into one plan.
Cost predictability: These plans have annual out-of-pocket limits. The benefits are lower costs and more predictable healthcare expenses.
Additional services: Many MA plans offer wellness programs, fitness memberships, and other health-related services Original Medicare doesn’t cover.

Cons

Network restrictions: You typically need to use doctors and hospitals within the plan’s network, which can limit your choice of healthcare providers. In many cases, you need to get a referral from your primary care doctor to see a specialist.
Regional limitations: MA plans limit coverage to network providers or a service area, which might be a concern if you travel frequently or spend part of the year in a different state.
Plan changes: Benefits, provider networks, and costs can change annually. These changes require you to review and possibly change plans each year to ensure your plan still meets your needs.^[2]

Enrollment for Medicare Advantage plans

Follow these steps to enroll in a Medicare Advantage plan:

Check eligibility. Ensure you’re eligible for Medicare Part A and Part B, which is a prerequisite for enrolling in an MA plan. In addition, you must be a U.S. citizen (or lawfully present in the U.S.) and live in the plan’s service area.
Wait for the enrollment period. You can’t enroll in an MA plan whenever you want. You can join only during an enrollment period.
Research plans. Use the Medicare Plan Finder tool at Medicare.gov to explore MA plans available in your area.
Compare quotes. Gather information and compare quotes from multiple insurance companies to understand each plan’s costs, benefits, and network restrictions.
Review plan details. Carefully review the plan’s summary of benefits, including coverage options, out-of-pocket costs, provider networks, and additional benefits.
Enroll. Once you choose a plan, enroll online at Medicare.gov, directly with the insurance company, or by calling 1 (800) MEDICARE.

When you can enroll in an MA plan

You can enroll in an MA plan only during an enrollment period. Here are the key enrollment periods to know about.

Initial enrollment period: This is your first opportunity to enroll in an Original Medicare and an MA plan. It begins three months before the month you turn 65, includes your birth month, and ends three months after.^[3] For example, if your birthday is in June, your initial enrollment period runs from March 1 to Sept. 30.
Annual enrollment period: The annual enrollment period, or open enrollment, occurs from Oct. 15 to Dec. 7 each year. During this time, you can join a new plan, switch from one plan to another, drop an MA plan to return to Original Medicare, or add or drop Part D prescription drug coverage. If you enroll in a new plan during open enrollment, your new coverage will start on Jan. 1.
Medicare Advantage open enrollment period: This enrollment period runs from Jan. 1 through March 31 each year if you’re already enrolled in a Medicare Advantage plan. You can switch MA plans or return to Original Medicare during this window.
Special enrollment periods: Some life events trigger special enrollment periods, allowing you to join a plan or switch plans outside the regular enrollment windows outlined above. Examples of these events include moving out of your plan’s service area, losing other insurance coverage, your plan changing its contract with Medicare, and qualifying for Medicaid.

Medicare Advantage plan FAQs

Enrolling in Medicare can be complicated, so it’s important to understand your options. Below is some additional information about Medicare Advantage plans to help you better understand how they work and whether they might be right for you.

What’s the difference between Original Medicare and Medicare Advantage?
The federal government administers Original Medicare, while private insurance companies that contract with Medicare provide Medicare Advantage plans. These plans often include additional benefits, like prescription drugs, dental, and vision coverage.
What are the disadvantages of a Medicare Advantage plan?
Medicare Advantage plans require you to see healthcare providers within their specific provider networks. They also have the potential for higher out-of-pocket costs and regional limitations that could affect your coverage when you travel.
Can you switch from traditional Medicare to Medicare Advantage?
Yes. You can switch during the annual enrollment period, which runs from Oct. 15 to Dec. 7 each year, or during the Medicare Advantage open enrollment period, which runs from Jan. 1 through March 31 each year.
Why do people choose Medicare Advantage?
People choose Medicare Advantage plans when they want more comprehensive coverage than Original Medicare provides or a cap on out-of-pocket costs under Medicare Parts A and B.

Sources

U.S. Department of Health & Human Services Centers for Medicare & Medicaid Services. "Understanding Medicare Advantage Plans."
Medicare.gov. "Plan Annual Notice of Change (ANOC)."
Medicare.gov. "When does Medicare coverage start?."

Janet Berry-Johnson

Janet Berry-Johnson, CPA is a freelance writer with a background in accounting and income tax planning and preparation. She's passionate about making complicated financial topics accessible to readers. She lives in Omaha, Nebraska with her husband and son and their rescue dog, Dexter. Visit her website at www.jberryjohnson.com.

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Edited byEvelyn PimplaskarEditor-in-Chief, Director of Content

Evelyn PimplaskarEditor-in-Chief, Director of Content

10+ years in insurance and personal finance content
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Evelyn leads Insurify’s content team. She’s passionate about creating empowering content to help people transform their financial lives and make sound insurance-buying decisions.

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