Which Should You Trust Your Health To?

What Original Medicare and Medicare Advantage Cover

Original Medicare comprises Part A (inpatient hospital care) and Part B (outpatient care). You can add a prescription drug plan, known as Part D, for an additional cost. Medicare Advantage plans are required to provide the same Part A and Part B services and almost always include Part D.

While Original Medicare and Medicare Advantage offer most of the same coverage, Medicare Advantage, which is also called Part C, can offer additional benefits that Original Medicare doesn’t cover. These include vision, dental, and hearing coverage, as well as other supplemental benefits.

“Most seniors on Original Medicare enroll in both of these parts, though some may delay Part B for various reasons, such as continuing to work,” said Dan Hardle, CEO of Agent Boost Marketing, which specializes in Medicare Advantage and Part D plans. “Additional coverage, such as prescription drug coverage, is not included. If insurance is needed for these, those can be purchased for additional costs as supplemental insurance plans.”

Part A

Medicare Part A covers inpatient hospital care, including semi-private rooms and drugs you receive there, skilled nursing facility care, and hospice stays. 

Part A may also cover treatment received at home, such as physical and occupational therapy, social services, and skilled nursing or home health aide services.

Part B

Medicare Part B covers outpatient care, medically necessary doctor’s office visits (though not routine visits such as physical exams or eye exams), durable medical equipment, preventive services, and mental health services. Home health services may also be covered by Part B if not covered by Part A.

Outpatient services are a broad category that includes everything from regular checkups to chemotherapy. Part B covers services such as flu shots and vaccines, cancer and STD screenings, opioid use disorder treatment, and diabetes screening and treatment.

Part D

Prescription drugs are covered under Medicare Part D, which private insurance companies offer. Original Medicare enrollees must buy Part D separately, but 88% of Medicare Advantage plans include drug coverage in 2025.

Supplemental Benefits

Medicare Advantage covers the same medically necessary services as Original Medicare, and it may offer coverage for services that Original Medicare doesn’t cover.

While these extra benefits vary from plan to plan, 97% of Medicare Advantage plans offer coverage for dental, hearing, and vision care, which aren’t covered except in limited capacity under Original Medicare. Some also offer gym memberships, telehealth, and meal benefits.

How Much Original Medicare and Medicare Advantage Cost

A major difference between Original Medicare and Medicare Advantage is the out-of-pocket cost. As with other types of health insurance, Medicare costs comprise premiums, deductibles, copays, and coinsurance.

Original Medicare Costs

Under Original Medicare, you may need to pay costs for Part A, Part B, and a prescription drug plan.

Part A

Most people don’t need to pay anything for Part A because they’re eligible to receive it premium-free. If you’re not eligible, you’ll pay $285 per month at a minimum. You’ll also need to pay a $1,676 deductible out of pocket per benefit period.

For inpatient hospital coverage under Part A, after you’ve met your deductible, your out-of-pocket costs break down like this:

• Days 1-60 for each benefit period: $0 
• Days 61-90: $419 per day
• After day 90: $838 per day for each lifetime reserve day

Medicare Advantage plans have different costs per day for inpatient services, and they vary from plan to plan. For example, the Aetna Medicare Eagle PPO requires enrollees to pay $395 per day for days 1 through 6 of inpatient hospital coverage, then nothing for days 0 through 90, as long as the hospital is in-network. But if the hospital is out of network, you’ll pay 50% of the entire stay.

Part B

Part B’s monthly premium is $185 in 2025, although you may have to pay an extra charge (the Income Related Monthly Adjustment Amount, or IRMAA) if your modified adjusted gross income exceeds $106,000 (or $212,000 if you file a joint tax return).

You also must pay the Part B premiums with a Medicare Advantage plan. However, about one-third of MA plans subsidize all or part of your Part B premium.

Under Original Medicare Part B, you’ll pay a $257 annual deductible before Medicare starts to pay for covered services. After meeting your deductible, you’ll pay 20% coinsurance (based on the Medicare-approved cost) for services covered under Part B.

For Medicare Advantage, your out-of-pocket costs for outpatient services vary by plan. Because private companies offer the plans, they can decide how much they’ll pay. You may end up paying a flat-rate copay (e.g., $35) or coinsurance (e.g., 50% of Medicare-approved costs for out-of-network care), depending on what the plan covers and whether it shares costs for out-of-network treatment.

Original Medicare Supplemental Plans (Medigap)

With Original Medicare, you can buy supplemental coverage to help pay for your out-of-pocket costs.

Medigap

Medicare supplement insurance, known as Medigap,  is a standalone supplemental plan that you can purchase from a private company to help with your Part A and Part B out-of-pocket costs. You can only get Medigap if you’re enrolled in Original Medicare—in fact, it’s illegal for someone to sell you a Medigap plan if you’re enrolled in Medicare Advantage.

Medicare supplement coverage includes Medigap Plans A, B, C, D, F, G, K, L, M, and N. Plans F and G, the most comprehensive plans, also offer high-deductible versions. You can only enroll in Plan F if you were eligible for Medicare before Jan. 1, 2020.

Medigap plans are standardized according to federal and state laws, but they can cover your out-of-pocket costs in different ways. For example, some might pay 100% of your Part A coinsurance, while others would cover 50% to 100% of your Part B coinsurance, copays, or deductibles. 

Extra Help

Medicare enrollees with limited income and financial resources may qualify for Extra Help. This program pays some or all of your prescription drug coverage under both Original Medicare and Medicare Advantage.

Medicare Advantage Costs

Medicare Advantage has its own separate premiums, deductibles, coinsurance, and copays. Some of these have been discussed above in relation to the inpatient and outpatient coverages offered by Part A and Part B.

In practice, 60% of Medicare Advantage enrollees pay nothing in premiums, and premium costs overall average about $17 in 2025. About one in three MA plans will also reimburse you for all or part of your Part B premium.

Nick Shrader, owner and CEO of Second Western Insurance Services, said if you want low premiums and added benefits, then Medicare Advantage may be a good fit, especially if your doctors are in-network. “If you are a frequent traveler or enjoy open provider access, Original Medicare with a Medigap plan may be for you,” he said.

Most Medicare Advantage plans also don’t have a deductible for health care services but could require you to pay a deductible for prescriptions, known as the drug deductible. In 2025, the average drug deductible is $306.10, and no drug deductible can exceed $590.

You’ll pay copays and/or coinsurance at the point of service, with costs increasing if your plan is subject to a provider network and the provider is out-of-network. Your copays could range from $0 to hundreds of dollars or more, and your coinsurance could reach as high as 50% of the cost for out-of-network care. You could also be responsible for the entire cost out of pocket if your plan doesn’t include out-of-network care.

Part D Costs

Medicare Part D costs extra when you add it to your Original Medicare coverage. Premiums vary based on the prescription drug plan—Part D plans, like Medigap, are run by private companies—and the average premium is about $46.50 in 2025.

In addition, higher-income households may have to pay an extra amount, called IRMAA, on top of their prescription drug plan premiums. Whether you have to pay IRMAA and how much depends on your tax filing status and reported income two years ago.

Starting in 2025, out-of-pocket drug costs are capped at $2,000 for both Original Medicare and Medicare Advantage. You won’t pay anything for prescription drugs after reaching this limit.

Original Medicare vs. Medicare Advantage: Maximum Out-of-Pocket Limit

Original Medicare doesn’t have a maximum out-of-pocket (MOOP) limit unless you have Medigap or supplemental coverage from an employer-run health care plan or from your union that will cover out-of-pocket costs. Without a MOOP limit, you’ll always have to pay the designated out-of-pocket costs, such as your 20% coinsurance, for covered services.

Medicare Advantage plans do have maximum out-of-pocket limits. Once an enrollee reaches that limit, they won’t have to pay anything else for covered services for the remainder of the year. 

Note, however, that MA plans often have high out-of-pocket limits; the maximum allowed in 2025 is $9,350. 

Coverage Limitations With Original Medicare and Medicare Advantage

Medicare Advantage plans are required to offer the same coverage as Part A and Part B. Coupled with the usually included Part D coverage and extra benefits not covered by Original Medicare, MA seems like it would be the better choice hands down. However, Medicare Advantage comes with some significant limitations.

Provider Networks May Limit Your Health Care Choices

If you have Medicare Advantage, depending on your plan, the providers you’re allowed to see for care and the facilities at which you’re allowed to receive care may be limited by your plan’s network. Health maintenance organization (HMO) plans typically offer no coverage for out-of-network services, while preferred provider organization (PPO) plans usually cover out-of-network services but at a higher cost.

Original Medicare doesn’t use networks to determine coverage—you can receive the same level of coverage from any provider in the country who accepts Medicare.

Prior Authorization and Referrals to See a Specialist

For many covered services, Medicare Advantage enrollees will need to get advanced approval, also known as prior authorization, before the plan will cover costs. Your health care provider must ask for prior authorization on your behalf. That can lead to delays and denials of care, with 3.2 million prior authorization requests partially or fully denied in 2023, according to the KFF’s most recent data.

Original Medicare typically covers most services and supplies without prior authorization. 

Likewise, you’ll need to get a referral from your primary care doctor to see a specialist under many types of Medicare Advantage plans, while Original Medicare only requires referrals in specific cases, such as for a routine EKG screening after your Initial Welcome to Medicare doctor visit.

Coverage While Traveling

Original Medicare will cover you anywhere in the country as long as the provider or facility accepts Medicare. However, with Medicare Advantage, your coverage is limited to a designated service area that is set by your plan sponsor.

Neither type of Medicare will cover medical care while you’re traveling abroad, although some Medigap policies—only available for Original Medicare enrollees—may pay for emergency care while you’re out of the country.

Best Medicare Advantage Plans

If you think a Medicare Advantage plan might be right for you, it’s worth checking out Investopedia’s list of the best Medicare Advantage plans to see if one is right for you. 

Cigna

Cigna has some of the lowest costs among MA plans, with average monthly premiums at $5.50 for Medicare Advantage plans with prescription drug coverage and an average annual out-of-pocket maximum of $5,471. Notably, 98% of Cigna’s plans feature a $0 drug deductible. In addition to these affordable costs, Cigna is rated among the highest for customer experience.

Alignment Health

Alignment Health had the fourth-lowest average premiums of the MA plans Investopedia reviewed and the lowest out-of-pocket maximum, at $3,524. While Alignment plans are only available in five states, the company had the second-highest Medicare star ratings, which measure plan quality. However, Alignment has a low rating for customer service, which may not make its low costs worth it.

Aetna

Aetna has one of the widest coverage areas of any Medicare Advantage plan provider reviewed by Investopedia. Compared to other companies of its size, Aetna had some of the lowest premiums for Medicare Advantage plans with prescription drug coverage, but also a higher-than-average out-of-pocket maximum of $6,054.

Kaiser Permanente

Kaiser Permanente’s MA plans have relatively high premiums, according to Investopedia’s research, but they have some of the lowest prescription drug deductibles. Most Kaiser plans have no drug deductible at all. In addition, the company has the highest average Medicare star rating, indicating excellent plan quality. Unfortunately, Kaiser Permanente only offers plans in eight states.

Humana

While Humana’s Medicare Advantage plans generally have above-average premiums and high out-of-pocket maximums, the company is well-rated for its special needs plans (SNPs), which are tailored to people with severe or chronic health conditions. Humana offers every type of SNP and has some of the lowest premiums for those plans.