Original Medicare or Medicare Advantage?
There are two main routes through Medicare. Neither is right for everyone. Here is how they differ, and the questions that help you decide between them.
How the two routes compare
A general picture. Each Medicare Advantage plan sets its own rules, so check the plan's own documents too.
| Original Medicare (Parts A and B) | Medicare Advantage (Part C) | |
|---|---|---|
| Who runs it | The federal government, through Medicare. | A private insurance company that Medicare approves. |
| Doctors and hospitals | Any doctor or hospital in the country that accepts Medicare. | Usually a network. Going outside it can cost more or not be covered, except in an emergency. |
| Referrals | Not needed to see a specialist. | Often needed, depending on the plan. |
| Drug coverage | Not included. Add a separate Part D plan. | Included in most plans. |
| Dental, vision, hearing | Mostly not covered. | Many plans include some of each. Check the details plan by plan. |
| Your share of costs | Deductibles and coinsurance, with no yearly limit unless you add Medigap. | Copays and coinsurance set by the plan, with a yearly limit on what you pay for covered care. |
| Travel | Works the same anywhere in the U.S. | Routine care is usually tied to the plan's area. Emergency care is covered anywhere in the U.S. |
| Adding Medigap | Yes, to help with the costs Medicare leaves to you. | No. Medigap cannot be used with a Medicare Advantage plan. |
Eight questions to ask about any plan
Your guide includes this checklist with space to write the answer for each plan you look at.
- Are my doctors covered?Check each plan's network, or that they accept Medicare.
- Are my prescriptions on the drug list?Look up each one, and the tier it sits on.
- Which pharmacies can I use?Some plans charge less at preferred pharmacies.
- What is the most I could pay in a year?Add the premium to the plan's yearly limit.
- Do I spend time in another state?A network plan may only cover emergencies there.
- Will I need referrals?Some plans ask for one before you see a specialist.
- Do I have coverage from work or a union?Ask how it works alongside Medicare first.
- Do I need dental, vision or hearing cover?Compare what each plan includes, and its limits.
Look up plans on Medicare.gov
The Medicare Plan Finder lists the plans in your ZIP code, with their drug lists and costs. Your guide walks you through using it.
Get free one-to-one help
Every state has a State Health Insurance Assistance Program with trained counsellors who sell nothing. Find yours at shiphelp.org.
Ask us about your guide
If something in your guide is unclear, email us and a person replies within one working day. We explain, and the choice stays yours.