Medicare is the federal health insurance program in the United States. It is available to anyone aged 65 and over and is also available to young people with disabilities. There are several Medicare options, including Original Medicare and Medicare Advantage. Which program is right for you depends on many factors.
Disclaimer: Patients should consult official Medicare resources, including Medicare.gov, or contact Medicare directly to make coverage or enrollment decisions.
What is Original Medicare?
Original Medicare—also sometimes called traditional Medicare or simply Medicare—is the primary health insurance option offered to qualified individuals. Someone who is enrolled in Medicare is called a beneficiary. Under Original Medicare, beneficiaries can choose any Medicare provider.
There are two parts to Original Medicare:
- Medicare Part A includes inpatient hospital care, nursing facility care, hospice care, and some medical services. The coverage usually does not require beneficiaries to pay a monthly premium.
- Medicare Part B includes ambulatory care, physician services, preventive services, and long-term medical equipment. Coverage usually requires beneficiaries to pay a monthly premium.
Medicare Part D, vision and dental coverage for Original Medicare
Original Medicare does not include vision and dental coverage. Vision and dental plans are available to Original Medicare beneficiaries from private insurers.
Similarly, original Medicare does not include independent drug coverage. This type of plan is called Part D, and it’s also available as a stand-alone plan from private insurers.
What is Medicare Advantage?
Medicare Advantage is a special type of Medicare plan. They are offered by Medicare-approved private insurance companies as an alternative way to receive Part A and Part B benefits. Medicare Advantage Plans:
- Cover all services included in Part A and Part B
- Usually includes Part D coverage
- May include vision, hearing and dental coverage
However, Medicare Advantage plans do not provide much flexibility. You should generally use the plan’s provider network, except for emergencies or urgent care. Plans may also require prior authorization for certain services, procedures, or drugs.
Original Medicare
Basic coverage.
- Choosing a provider: Nationwide access to any provider that accepts Medicare
- Coverage structure: Separates hospital, medical and pharmaceutical insurance
- Additional benefits: None
- Costs and regulations: Higher monthly premiums, with no additional fees
Medicare Advantage
Custom coverage.
- Choosing a provider: Care is limited to the provider’s network
- Coverage structure: Usually includes hospital, medical and drug coverage
- Additional benefits: May include additional benefits
- Costs and regulations: Low monthly payment with fees, networks and pre-authorization
Enrollment differences between Medicare Part A and B and Part C
Original Medicare usually provides continuous coverage after you enroll without choosing an annual plan or re-enrolling. Medicare Advantage limits when beneficiaries can join, change, or leave specific enrollment periods each year if they don’t qualify for a particular enrollment period.
Because Medicare Advantage plans operate on an annual cycle, beneficiaries should expect to actively consider plan options and changes each year. These enrollment rules may affect when coverage begins, which plans are available, and how easily changes can be made. Understanding enrollment timing is an important part of choosing which Medicare coverage option best suits your beneficiary’s needs.
Can I switch between Original Medicare and Medicare Advantage and back?
Yes, you can technically switch between Medicare plans, but switching can be difficult due to Medigap rules.
When individuals first enroll in Medicare — usually around age 65 — they have a limited window to purchase a Medigap policy without medical underwriting. Outside of this period, insurers in most states may deny coverage, charge higher premiums, or impose waiting periods based on medical conditions. Beneficiaries who transition later may face limited or no Medigap options.
While a few states offer broader consumer protections, Medigap enrollment is limited in most states, making it important to consider long-term coverage needs before switching plans.
What to know after choosing coverage
If you choose Original Medicare, it will continue automatically after you enroll. Beneficiaries can still make separate decisions about drug coverage (Part D) or Medicare supplemental insurance (Medigap).
Medicare Advantage plans, on the other hand, operate like most other private insurance plans. Each year, you can make changes to your benefits and provider networks during the annual enrollment period.
Review your official Medicare materials for the best understanding of enrollment deadlines and plan rules. This will help you make the best coverage decisions.
What to ask before choosing a plan
- Can I continue to see my current primary care doctors and specialists?
- Are my preferred hospitals and other providers in the plan’s network?
- Do I want the flexibility of looking at providers across the country, or am I comfortable using a local network?
- Does the plan require referrals to see specialists?
- Is prior authorization required for medications, imaging, procedures, or other services?
- Have I reviewed how and when I can change my enrollment or coverage?
- Have I considered how enrollment rules—including Medigap availability—may affect my ability to change coverage later?
- Are my prescription drugs covered and what will I pay at the pharmacy?
- What are the total costs I can expect each year (premiums, deductibles, copayments, coinsurance, and out-of-pocket limits)?
- Are additional benefits included (such as dental, vision, hearing, fitness, or transportation) and can I expect to use them?
- If my health needs change, will this coverage still meet my needs?
- Are there travel or out-of-region care restrictions I should be aware of?
