When you first enroll in Medicare at age 65, you have two options for receiving your health care coverage: through original Medicare (Parts A and B) or through a private Medicare Advantage (Part C) plan.

How are original Medicare and Medicare Advantage different? Below is an overview of each type of plan to help you understand the main distinctions between the two.

What is original Medicare?

Original Medicare (also called “traditional Medicare”) refers to Medicare Parts A and B. It operates on a fee-for-service structure. This means you can go to any health care provider or hospital in the U.S. that accepts Medicare. When Medicare-covered services are billed, Medicare pays a portion of the costs and you pay the rest yourself. These are called your out-of-pocket Medicare costs. You can enroll in original Medicare during your Initial Enrollment Period, the General Enrollment Period (Jan. 1-March 31), and a Special Enrollment Period if you qualify for one.

You might be wondering, “Does Medicare cover acupuncture?” or “Does Medicare cover cataract surgery?” Original Medicare has very specific rules about what services it will and will not cover. While the program covers medically necessary inpatient and outpatient health care and medical supplies, it doesn’t cover all medical expenses.

Which type of care is not covered by Medicare Parts A and B? Examples include routine vision care, hearing aids, dental care, and most long-term care.

Another common question is “Does original Medicare pay for prescriptions?” The answer is no. Parts A and B do not cover prescription medications. If you want this coverage through Medicare, you can purchase a standalone Part D plan. Part D plans are sold through private insurance comapnies, and what you pay out of pocket will vary by plan. 

Now, let's take a look at another way to receive your Medicare health benefits: Medicare Advantage.

What is Medicare Advantage?

Medicare Advantage (also called Part C) refers to Medicare plans that are offered privately through health insurance companies. If you choose to join a Medicare Advantage plan, you still have Medicare—you just receive your Parts A and B coverage through a private health plan. Most Medicare Advantage plans include Part D, eliminating the need to buy a separate plan.

Medicare Advantage plans come in various forms, including health maintenance organizations (HMOs), preferred provider organizations (PPOs), and private fee-for-service plans. Most plans use a specific network of doctors and hospitals. That means health care services are only covered by Medicare if you receive them from in-network providers and facilities.

You can join a Medicare Advantage plan during your Initial Enrollment Period, the Annual Open Enrollment Period (Oct. 15-Dec. 7), or a Special Enrollment Period if you qualify for one.

Are Medicare Advantage plans worth it?

The answer is that it depends on your unique needs. Medicare Advantage plans cover all of the same services offered under original Medicare—but they may also cover additional services such as:

• Routine vision care and eyeglasses
• Hearing aids
• Dental care

Most Medicare Advantage plans also offer some degree of supplemental benefits, which can include:

• Health club memberships
• Non-medical transportation
• Pre-loaded debit cards for health-related expenses (flex card)
• Home meal and grocery delivery

With a Medicare Advantage plan, you still have certain out-of-pocket costs. You must pay your monthly Part B premium. On top of that, you may also pay an additional monthly plan premium. Some services even require you to pay a deductible and a portion of the cost of the services.

Another thing to consider is that Medicare Advantage may not give you as much choice in the providers you see for your care. As mentioned above, many of these private plans have a designated network of providers in the geographic area they serve. With the exception of emergencies, or unless you have a PPO, they may not provide coverage if you decide to visit an out-of-network provider. You may also need a referral to visit a specialist, unless you have a PPO.

What's another important difference between original Medicare and Medicare Advantage? Supplemental insurance. With original Medicare, you can opt to pay an additional premium for a Medigap policy, which helps cover Medicare cost-sharing (out-of-pocket costs). You do not have this option if you enroll in a Medicare Advantage plan.

Quick-reference guide: original Medicare vs. Medicare Advantage

This flyer, created with our partners at the Medicare Rights Center, can help you understand the major differences between original Medicare and Medicare Advantage plans. This includes coverage and network options and costs.

Have questions about your current Medicare plan?

Can I change my Medicare plan at any time? What is the highest rated Medicare Advantage Plan? If you have questions about your Medicare coverage, help is available from your local State Health Insurance Assistance Program (SHIP).

To connect with a Medicare benefits counselor in your area, visit the SHIP website, email info@shiphelp.org, or call the SHIP National Technical Assistance Center toll-free at 1-877-839-2675.