Original Medicare vs. Medicare Advantage

Comparison Overview

Original Medicare (Parts A & B) is the traditional federal program. You can see any doctor or hospital nationwide that accepts Medicare—no networks or referrals—and you can add a stand-alone Part D plan for outpatient drugs. Because Original Medicare has no annual out-of-pocket maximum (MOOP), many people buy a Medicare Supplement (Medigap) policy to help pay deductibles and coinsurance, trading a higher monthly premium for very predictable costs and maximum provider freedom (great for travelers and “snowbirds”).

Medicare Advantage (Part C) is an all-in-one alternative offered by private insurers that deliver your Part A & B benefits—often including Part D and extras like dental, vision, hearing, fitness, or OTC allowances. Plans typically use networks (HMO/PPO), may require referrals/prior authorization, and set fixed copays/coinsurance with an annual Maximum-Out-Of-Pocket (MOOP) that limits your medical spending for A/B services. It can mean lower premiums and one card, but you accept plan rules and local networks; drug formularies, provider participation, and benefits vary by county and plan.

Original Medicare vs. Medicare Advantage Comparison Table

Original Medicare	vs.	Medicare Advantage
Federal government (CMS).	Who runs it	Private insurers contracted with CMS; must cover A & B services and follow Medicare rules.
Part A (Hospital) + Part B (Medical). Add Part D (drug plan) separately if desired.	What it includes	All A & B benefits, and often Part D (MA-PD) in one plan. May include extras (dental, vision, hearing, fitness, OTC).
Any doctor/hospital nationwide that accepts Medicare—no networks or referrals.	Provider access	Networks (HMO, HMO-POS, PPO, PFFS). Out-of-network rules vary by plan; HMOs generally require in-network care (except emergencies/urgent care visits).
No referrals for specialists; minimal prior authorization (some DME, home health, etc.).	Referrals / prior authorization	Referrals and prior authorization are common for many services; extent varies by plan/type.
Not included. Choose a stand-alone PDP if you want outpatient drug coverage.	Drug coverage (Part D)	Often included (MA-PD). If MA plan lacks Part D, you may or may not be allowed to add a stand-alone PDP (varies by MA type—PPO sometimes yes; HMO generally no).
None (no cap) under OM alone; risk is open-ended unless you add Medigap.	Annual out-of-pocket maximum (MOOP)	Yes. Each MA plan has a MOOP for Part A/B services; once reached, the plan pays 100% for covered A/B care for the rest of the year.
Part B premium (and Part A if not free), plus deductibles/20% coinsurance for most B services. With Medigap + PDP, you pay extra premiums but reduce cost variability.	Cost structure	Usually pay Part B premium (some plans reduce Part B via giveback). Plan may have $0–low premiums, set copays/coinsurance, and an annual MOOP; drug copays if MA-PD.
National program rules; appeals through Medicare.	Quality oversight	CMS Star Ratings (1–5) influence bonuses and plan quality; plan-level utilization management applies.
Generally not included (some employer or Medigap plans may offer limited extras).	Extras (DVH, fitness, OTC, rides, meals)	Often included as supplemental benefits (vary widely by plan and county).
Strong for frequent travelers—nationwide access wherever Medicare is accepted.	Travel / snowbirds	Depends on network. PPOs may allow some out-of-network; HMOs typically local/regional. Emergencies/urgent care covered anywhere. Some PPOs better for multi-state living.
People who want maximum provider freedom, travel often, or prefer pairing with Medigap for predictable costs.	Best fit (typical)	People who want one card, MOOP protection, predictable copays, and extra benefits, and who are comfortable with networks/prior authorization.

Original Medicare vs. Medicare Advantage Comparison Table

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