Original Medicare and Medicare Advantage offer the same Part A and Part B benefits. However, they differ in healthcare professional network rules, prescription drug coverage, and availability of additional benefits.
Each Medicare plan has pros and cons. Both Original Medicare and Medicare Advantage have limitations and benefits for their users.
This article compares Original Medicare and Medicare Advantage plans and explains the premiums that people can expect to pay.
Glossary of Medicare terms
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Original Medicare is a government health insurance program that covers hospital and medical costs. It consists of Part A and Part B.
Part A covers hospital costs, including inpatient care in a hospital, care in a skilled nursing facility while recovering from a health condition, and hospice care.
Part B covers outpatient medical costs, including preventive care services, doctor visits, laboratory tests, durable medical equipment, and some home health services.
Original Medicare offers limited coverage for prescription drugs, but a person can opt to add a stand-alone Medicare Part D prescription drug plan.
Learn more about Original Medicare.
Private insurance companies that Medicare has approved administer Medicare Advantage plans. These plans are also known as Medicare Part C plans.
Medicare Advantage plans are an alternative to Original Medicare. They combine the benefits of parts A and B and often include Part D coverage as well. Many plans also offer coverage for wellness programs and vision, dental, and hearing care.
There are four main types of Medicare Advantage plans, some of which have strict rules about in-network healthcare professionals.
In 2024, 32.8 million people enrolled in Medicare Advantage plans, according to the nonprofit KFF.
Learn more about Medicare Advantage (Part C).
The table below shows the differences between these two Medicare options:
| Original Medicare | Medicare Advantage | |
|---|---|---|
| Costs | Standard charges for Part A and Part B costs apply, including a monthly Part B premium. After paying the Part B deductible, a person will pay a 20% coinsurance for covered services with participating healthcare professionals. | Costs depend on the specific plan. A person may have a copayment for in-network care. People must pay the Medicare Part B premium. Medicare Advantage plans may also charge an additional monthly premium. |
| Supplemental insurance (Medigap) | A person can pay an additional premium for Medigap to cover some out-of-pocket Medicare costs. | Medigap is not available. |
| Prescription drug coverage | A person may have limited prescription drug coverage in certain situations. | Most plans include drug coverage. |
| Healthcare professional access | A person can choose any doctor who accepts Medicare. A person does not need a doctor’s referral to see a specialist. | Some Medicare Advantage plans require people to use only in-network healthcare professionals. A person may need a referral to see a specialist. |
| Extra benefits (e.g., vision, hearing, dental) | No extra benefits are included. | Many plans offer extra benefits. |
| Covered services for travel anywhere in the United States | Yes, this coverage is included. | Not all plans provide out-of-state coverage. A person can check with their plan provider to confirm. |
| Out-of-pocket costs | Yes. Out-of-pocket costs include premiums, deductibles, and copays. | Generally, yes. Costs include premiums, deductibles, and copays. |
| Deductibles | Yes. The deductible is $257 before Original Medicare begins to pay. | Some plans have deductibles, which may vary by plan and location. |
| Coinsurance and copayments | Generally, yes. This is usually around 20% of covered costs. | Generally, yes. These will vary depending on the plan and provider. |
| Premiums | Most people are eligible for premium-free Part A. Most people pay a monthly Part B premium. | Premiums vary but start at $0. People must also pay the Medicare Part B monthly premium directly to Medicare, not to the plan provider. |
| Maximum out-of-pocket spending limit | none | Plans pay the full cost of eligible care after the insured person reaches a specified limit. |
Medicare premiums vary in cost depending on a person’s circumstances.
Premium-free Part A
If a person or their spouse paid Medicare taxes for 40 quarters while working, they typically do not pay a premium for Part A. Medicare refers to this as premium-free Part A.
Part A
According to the Centers for Medicare & Medicaid Services (CMS), if someone has to buy Part A coverage in 2025, they will pay $518 per month if they have paid Medicare taxes for fewer than 30 quarters.
Those who paid Medicare taxes for 30 to 39 quarters will pay a 2025 monthly premium of $285, per the CMS.
Part B
Medicare bases this premium on a person’s income from the previous 2 years.
The standard Part B premium in 2025 is $185 per month.
Part D
People who want coverage for prescription medications may opt to add a Part D prescription drug plan. The monthly premiums for these plans vary. As with Medicare Advantage plans, private insurers administer Part D plans.
The national base premium in 2024 is $34.70. People who make more than $103,000 per year will have to pay extra fees on top of their monthly premiums.
Medicare Advantage
Medicare Advantage premiums vary depending on the selected plan.
Some insurance companies offer zero-premium plans with higher out-of-pocket expenses. In 2024, the average monthly premium for Medicare Advantage plans is $17.
People can compare Medicare Advantage plans using the plan finder tool on the Medicare website.
Here we look at some of the most frequently asked questions about Original Medicare and Medicare Advantage coverage.
Do Medicare Advantage plans replace Original Medicare?
It would not be accurate to say that Medicare Advantage replaces Original Medicare. Medicare Advantage plans offer an alternative way to receive Medicare health coverage with possible extra benefits.
Medicare rules state that Medicare Advantage plans must offer at least the same benefits as Original Medicare. However, the private medical insurance companies that administer the plans can provide additional benefits that Original Medicare does not offer.
With Medicare Advantage, a person still pays their Original Medicare premiums directly to Medicare, but they may also have to pay a separate premium to the plan provider.
How do I know whether I have Original Medicare or Medicare Advantage?
People can check their plan documentation, including their membership card, to confirm whether they have Original Medicare or Medicare Advantage.
Alternatively, people can access their policy information online at MyMedicare.gov. Once logged in, they can see their plan name and enrollment status.
Another option is to contact Medicare at 800-633-4227. A customer service representative can provide a person with their plan information.
Which Medicare plan is right for me?
A Medicare plan that suits one person may not meet another person’s needs. The best plan for each person will depend on factors such as their medical needs, finances, and location.
It is important that people carefully assess each plan to find the one that offers them the best healthcare coverage for their situation.
The State Health Insurance Assistance Programs (SHIP) National Network offers free, impartial advice to those who wish to discuss their health insurance plan options, including Medicare, in more detail.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
Private insurance companies administer Medicare Advantage plans as an alternative option for people who receive Medicare benefits.
People with a Medicare Advantage plan still receive their Original Medicare benefits.
Some people find that one option provides more significant cost savings. The pros and cons of the different plans depend on a person’s circumstances and location.
Independent advice is available through a person’s local SHIP center.