What is the Difference Between Original Medicare and Medicare Advantage?

MN Health Staff Writer | June 24, 2021

Although they sound similar, Original Medicare and Medicare Advantage are far from the same, yet they do share similarities. A few of the similarities are that they both provide medical coverage, you are eligible for both at 65, and both are regulated by the government. A few of the many differences between Original Medicare and Medicare Advantage are: 


Original Medicare: Only covers medical and hospital costs

Medicare Advantage: In addition to covering medical and hospital costs, many Medicare Advantage plans include dental, vision, and prescription drug coverage.


Original Medicare: On top of the monthly cost for Part B, there is no cap on the out-of-pocket payments you make. This can make Original Medicare very expensive if you have significant Part B medical expenses that are covered at 80% with no cap to your 20% of the expenses.  An example of this would be for someone that was going through cancer treatment on an out patient basis. 


Medicare Advantage: Have a maximum out-of-pocket amount that caps the amount you pay. Once you have hit your maximum out-of-pocket, your plan will pay 100% of the cost for most of the services covered on the plan.


Original Medicare: Within the country, you are covered, but must use hospitals and doctors that accept Medicare. Outside the country, Original Medicare will not cover you, even in emergencies. In extremely rare cases you may be covered but it is not something to rely on. 

Medicare Advantage: Many plans have national networks that will allow you to be covered anywhere within the country, although there are limitations on how long you can be out of state and still maintain coverage. Some plans cover you outside the country, but it will be on an emergency-only basis and will have a very high out-of-pocket maximum. 


Original Medicare: With Original Medicare, you can go to any doctor, hospital, or facility if it accepts Medicare.

Medicare Advantage: With a Medicare Advantage plan there will be rules on which doctors and hospitals you can visit. It will cost more to see a doctor or receive treatment out of network. 


Coinsurance vs. Copay

Original Medicare: With Original Medicare, you will pay a 20% coinsurance, which means you pay 20% of the cost for common health services such as office visits or surgery. 

Medicare Advantage: With a Medicare Advantage plan you may have a copay, which is a set amount that you would pay for any given visit, procedure, etc.

Overall, the choice to go with Original Medicare or Medicare Advantage is a personal choice that should consider many factors such as personal health, as well as the factors listed above. 

Category: Medicare Supplement