Original Medicare vs. Medicare Advantage

Original Medicare vs. Medicare Advantage: Which One is Right for You?

Navigating Medicare can feel like a daunting task, especially when deciding between Original Medicare and Medicare Advantage. Each option has its pros and cons, and the right choice depends on your healthcare needs, budget, and lifestyle. Let’s break it down so you can make an informed decision.

Understanding the Basics

Medicare is a federal health insurance program primarily for individuals aged 65 and older, as well as certain younger individuals with disabilities. There are two main ways to receive Medicare coverage:

• Original Medicare (also known as Traditional Medicare), which includes Part A (hospital insurance) and Part B (medical insurance). You can also add Part D (prescription drug coverage) and a Medigap supplemental policy to help with out-of-pocket costs.

• Medicare Advantage (Part C), which is offered by private insurance companies and includes Part A and Part B coverage. Most plans also include Part D and additional benefits like vision, dental, and wellness programs.

Key Differences Between Original Medicare and Medicare Advantage... See the chart above.

What Each Plan Covers

• Original Medicare covers inpatient hospital care (Part A) and outpatient medical services (Part B). However, it does not cover routine vision, dental, hearing, or long-term care.

• Medicare Advantage plans must cover the same services as Original Medicare, but many offer additional benefits like wellness programs, telehealth, and home-delivered meals.

Cost Considerations

Original Medicare Costs:

• Part A Premium: Usually free if you or a spouse paid Medicare taxes for 10+ years.

• Part B Premium: $185 per month in 2025. Some people will pay more based on income.

• Part D (Prescription Drug Plan): Costs vary based on plan selection (average $46.50 per month in 2025).

• Medigap (Supplemental Insurance): Helps cover out-of-pocket costs (average Plan G premium is $289 per month).

Medicare Advantage Costs:

• Part B Premium: Still required, but some MA plans cover part or all of this cost.

• Monthly Premium: Often $0 or low-cost ($17 on average in 2025).

• Copays and Coinsurance: Varies by plan; out-of-pocket costs are capped annually.

• Prescription Drug Coverage: Usually included in the plan with a separate deductible (average drug deductible is $306 in 2025).

Which One is Right for You?

Your decision depends on several factors:

• Do you want lower monthly premiums and extra benefits? Medicare Advantage may be the better choice.

• Do you want the flexibility to see any doctor without network restrictions? Original Medicare with a Medigap plan is a strong option.

• Do you travel frequently within the U.S.? Original Medicare allows coverage nationwide, whereas Medicare Advantage is typically limited to a specific area.

• Do you want a cap on your out-of-pocket expenses? Medicare Advantage plans have a maximum limit, while Original Medicare does not unless you have a Medigap policy.

Final Thoughts

Medicare Advantage and Original Medicare both provide excellent coverage, but the best choice depends on your healthcare needs, financial situation, and lifestyle. If you’re unsure, consulting with a licensed Medicare specialist can help you weigh the pros and cons based on your unique situation.

Have questions? Contact a trusted Medicare professional to explore your options and make the most informed decision for your healthcare future.