Original Medicare or Medicare Advantage?
They're two different ways to receive Medicare benefits. Understanding how they differ in provider access, costs, prescription coverage, travel and supplemental insurance can help you decide which questions matter most for you.
Compare the Two Options ↓Original Medicare
Medicare Part A + Part B administered by the federal government, with the option to add Part D and Medicare Supplement coverage.
Medicare Advantage
A Medicare-approved private health plan providing Part A and Part B benefits, usually with prescription coverage bundled in.
The difference isn't simply “government plan versus private plan.”
Both options provide Medicare-covered services. The important differences are in how your benefits are delivered and how you access healthcare.
Providers
Original Medicare generally offers broader provider choice. Medicare Advantage plans may use provider networks.
Drug coverage
With Original Medicare, Part D is usually separate. Many Medicare Advantage plans bundle prescription coverage.
Supplement coverage
Medigap can supplement Original Medicare. It is not used together with Medicare Advantage.
Extra benefits
Medicare Advantage plans may include additional benefits such as dental, vision or hearing coverage.
Original Medicare vs. Medicare Advantage
The federal Medicare program.
A Medicare-approved private insurance company.
Included directly through Original Medicare.
Provided through the Medicare Advantage plan.
Generally any doctor or hospital that accepts Medicare and agrees to treat you.
Often depends on the plan's provider network and plan type.
Original Medicare generally does not require referrals to see specialists.
Some Medicare Advantage plans may require referrals, depending on plan structure.
Usually obtained through a separate Part D drug plan.
Most Medicare Advantage plans include Part D prescription coverage.
Eligible beneficiaries may purchase Medicare Supplement insurance to help cover certain Original Medicare out-of-pocket costs.
Medigap is not used with Medicare Advantage.
Original Medicare alone does not have an annual out-of-pocket maximum for Part A and Part B services.
Medicare Advantage plans have an annual limit on covered Part A and Part B out-of-pocket spending.
Original Medicare does not generally cover routine dental, hearing aids or routine eye exams.
Plans may offer additional dental, hearing, vision or other benefits. Benefits vary by plan.
Generally broader nationwide access to Medicare-participating providers.
Non-emergency access outside a plan's service area may be more limited depending on the plan.
Start with the doctors and hospitals you actually want to use.
One of the most practical differences between Original Medicare and Medicare Advantage is how you access healthcare providers.
With Original Medicare, you can generally see any Medicare-approved doctor or facility that agrees to treat you and hasn't opted out of Medicare.
Medicare Advantage plans may instead use networks. For example, an HMO will generally require beneficiaries to receive non-emergency care from participating network providers, while PPO plans typically provide some ability to receive covered services outside the network, often at greater cost.
If you spend significant time in California, Arizona, Utah or another state—or travel frequently nationwide—provider access outside Nevada may deserve extra weight in your decision.
The lowest premium isn't necessarily the lowest-cost coverage.
Compare premiums together with deductibles, copays, coinsurance, prescription costs and your potential exposure when you need substantial healthcare.
Original Medicare approach
With Original Medicare, you continue paying applicable Medicare premiums and cost sharing.
- Part B generally includes coinsurance for covered services.
- Original Medicare by itself does not have an annual out-of-pocket maximum for Part A and Part B services.
- You may purchase Medigap coverage to reduce certain out-of-pocket costs.
- Part D prescription coverage typically has its own premium and cost-sharing structure.
Medicare Advantage approach
Medicare Advantage plan costs vary considerably by plan and location.
- You must continue to meet Medicare eligibility requirements and generally continue paying your Part B premium.
- Plan premiums may vary.
- Copays, deductibles and coinsurance vary by plan.
- Plans include an annual limit on covered Part A and Part B out-of-pocket costs.
Medigap and Medicare Advantage are not interchangeable.
Medicare Supplement Insurance—commonly called Medigap—is private supplemental coverage designed to work alongside Original Medicare.
A Medicare Advantage plan, by contrast, is another way to receive your Medicare Part A and Part B benefits.
You generally choose one pathway or the other:
Part A + Part B + optional Part D + optional Medigap.
A Medicare Advantage plan provides your Part A and Part B coverage and usually includes Part D prescription drug coverage.
If you're approaching age 65, Medigap enrollment timing deserves particular attention because your federal Medigap Open Enrollment Period is a limited opportunity.
Ask yourself these questions before comparing plans.
Do I want broad provider access?
Consider physicians, specialists, hospitals and health systems you want available to you.
Do I travel?
Frequent travelers and people who spend part of the year outside Nevada should pay particular attention to out-of-area coverage.
What medications do I take?
Compare formularies, pharmacy networks and prescription costs rather than assuming all drug coverage is equivalent.
Do I prefer bundled benefits?
Some people value having medical, prescription and additional benefits administered through one Medicare Advantage plan.
How important is cost predictability?
Think about total potential healthcare spending rather than comparing premiums alone.
Do I want Medigap?
If Medicare Supplement coverage appeals to you, understand that it works with Original Medicare—not Medicare Advantage.
Not sure which Medicare path makes more sense for you?
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Original Medicare vs. Medicare Advantage FAQs
Is Medicare Advantage the same thing as Medicare?
Medicare Advantage is a Medicare-approved private health plan that provides your Medicare Part A and Part B benefits instead of receiving those benefits directly through Original Medicare.
Can I see any doctor with Original Medicare?
You can generally use any doctor or facility that accepts Medicare and agrees to treat you. Medicare Advantage provider access depends on the particular plan and network structure.
Can I have both Medicare Advantage and Medigap?
No. Medigap is designed to supplement Original Medicare. It isn't supplemental coverage for Medicare Advantage.
Does Medicare Advantage include prescription coverage?
Most Medicare Advantage plans include Medicare Part D prescription drug coverage, although plan structures differ. With Original Medicare, beneficiaries who want drug coverage typically enroll in a separate Part D plan.
Does Medicare Advantage have an annual out-of-pocket maximum?
Yes. Medicare Advantage plans have an annual limit on covered Part A and Part B out-of-pocket costs. Original Medicare by itself does not have an equivalent annual out-of-pocket maximum.
Which is better in Nevada: Original Medicare or Medicare Advantage?
There is no single choice that's best for every Nevada beneficiary. The better fit depends on factors such as preferred providers, travel, prescription medications, budget, desired supplemental coverage and the Medicare Advantage plans available where you live.
Are Medicare Advantage plans the same throughout Nevada?
No. Medicare Advantage plans are offered by geographic service area. Plan availability, premiums, provider networks, benefits and cost sharing can therefore differ between communities such as Reno, Las Vegas, Henderson, Carson City and Elko.
Dig deeper into your Medicare options.
Important: NevadaHealthPlans.com provides general educational information and is not currently acting as a licensed insurance agency. This website is not connected with or endorsed by the U.S. government or the federal Medicare program. Information on this page is not individualized insurance, legal, tax, medical or financial advice. Medicare rules, plan availability, premiums, benefits, formularies, provider networks and enrollment requirements can change. For official Medicare information and current plan information, visit Medicare.gov.