As you research which Medicare plan is right for you, there are several options to consider. One important decision that you’ll have to make is between Medicare Advantage vs. Original Medicare. If you’re unsure about the specifics of each of these options, you’ve come to the right place. Below, you’ll find everything that you need to know about Medicare Advantage, Original Medicare, and which one is right for you.

One of the more popular Medicare questions is Medicare Advantage vs. Original Medicare – which is better? Is Medicare Advantage better than Original Medicare or is Original Medicare better? Generally speaking, Medicare Advantage usually turns out to be the better of the two. However, every person is unique and has specific healthcare needs. Therefore, knowing the differences between Medicare Advantage and Original Medicare is the key.

For example, Medicare Advantage tends to offer more coverage than Original Medicare. Medicare Advantage may also lower your out-of-pocket costs for healthcare – especially if you tend to visit the doctor’s office fairly often. On the other hand, Medicare Advantage plans have network-based coverage, meaning that it might not be a good option for folks who travel often. More information on the specifics of these choices is included below.

Medicare Advantage – Quick Overview

Essentially, Medicare Advantage plans are what you might describe as an “all in one” alternative to Original Medicare. They differ from standard Medicare plans in that they are offered by private companies, which must be approved by Medicare.

Medicare Advantage plans usually offer coverage for many different health-related services, including:

  • Vision
  • Hearing
  • Dental
  • Fitness Programs
  • And more

Some plans also include extra perks and benefits that cover services like transportation, over-the-counter drugs, and other services that promote your health and wellness. Since Medicare Advantage plans are sold by private companies, purchasers have some added flexibility in determining the exact nature of their plan.

Original Medicare – Quick Overview

Original Medicare is composed of two distinct parts: Medicare Part A and Part B. Part A is described as hospital insurance, whereas Part B is medical insurance. You can also get prescription drug coverage through Medicare Part D. However, this is an add-on service that must be paid for separately.

Individuals who have Original Medicare typically pay a deductible at the start of each new year. After that, they usually pay 20% of the costs of Medicare-approved services. Original Medicare ends up paying for much of the healthcare services and supplies that the average person utilizes. However, it doesn’t cover everything, which is why some people supplement it with additional insurance options.

Differences Between Medicare Advantage and Original Medicare

There are several differences between Medicare Advantage and Original Medicare. Each difference is covered in depth below.

Visiting the Doctor

Original Medicare patients have more freedom over the doctors they see. According to a study conducted by the Kaiser Family Foundation, 93% of primary care physicians participate in Medicare. Even better, you won’t have to get a referral to see a particular type of medical provider or worry about leaving a plan’s network.

Medicare Advantage works more like private insurance plans, such as Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO). You generally do have to worry about staying within your plan’s network. You also typically need a referral in order to see a specialist.

Covered Care

Original Medicare offers adequate coverage that will cover the bulk of your healthcare needs. Coverage includes diagnostic tests, outpatient surgery, hospitalization, blood work, and more. However, there are still many things that aren’t covered under this plan. For example, Original Medicare doesn’t offer coverage for dental, vision, or hearing care.

Medicare Advantage plans include broader coverage, streamlined convenience, and financial protection. Moreover, the average Medicare Advantage beneficiary has the option to choose among 47 plans, which lets you may find a plan that best suits your coverage needs. While Original Medicare only covers services approved under Part A and Part B, Medicare Advantage plans include everything that’s covered under Original Medicare, and most also cover prescription drug expenses and preventative dental, vision, and hearing care. You may even be able to get the costs of your gym membership covered by a Medicare Advantage plan. This means that if you want to maximize your coverage above all else, then a Medicare Advantage plan is clearly your best option.


Both Medicare Advantage and Original Medicare plans will require you to pay an annual Part B premium at the start of each year. Some Medicare Advantage plans have an additional annual premium on top of that amount.

After the premium has been met, patients with Original Medicare will pay 20% coinsurance for most types of healthcare. However, Medicare Advantage-covered individuals typically have a set copay amount for every doctor’s office visit. This is usually lower than the 20% coinsurance charged by Medicare.

Can You Be Enrolled in Medicare Advantage and Original Medicare at the Same Time?

No, you cannot be enrolled in both a Medicare Advantage plan and Original Medicare at the same time. Medicare Advantage includes all of the coverage that you would receive from an Original Medicare plan. You just pay for those services differently when you’re in a Medicare Advantage plan. So there’s no need to try and keep yourself enrolled in both of these plans at the same time.

Types of Medicare Advantage Plans

There are four major types of Medicare Advantage plans. They are as follows:

  • Health Maintenance Organization (HMO)
  • Preferred Provider Organization (PPO)
  • Private Fee-for-Service (PFFS)
  • Medical Savings Account (MSA)

Each of these can be a good option for different individuals. For example, HMOs are one of the cheapest forms of health insurance. However, they provide minimal out-of-network coverage. PPOs, on the other hand, offer extra flexibility since they don’t require you to use in-network doctors.

Types of Medicare Advantage Plans – Top 2 Most Popular

While there are several different types of Medicare Advantage plans to choose from, HMOs and PPOs are clearly the two most popular options. In fact, most people who sign up for Medicare Advantage do so with one of these two plan types. The reason for this is clear: Both HMOs and PPOs offer a number of benefits that should appeal to virtually everyone. Their benefits include:

  • $0 monthly premiums for many plans
  • $0 deductibles for every plan
  • Highly stable rates
  • A broad range of plan options
  • Inclusion of extra perks, such as wellness coaching and transportation to medical appointments
  • National availability
  • And more

If you’d like to learn more about your Medicare coverage options, feel free to fill out this form or give us a call anytime. Time for 65’s partnered licensed agents are focused on giving you the information you need, with zero pressure to enroll in a plan.