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Original Medicare vs. Medicare Advantage

One important and common question most people usually ask is, “Should I opt for Original Medicare or a Medicare Advantage plan?” 

If you are trying to decide which Medicare plan is best for your health coverage and budget, this is a great place to start. Let’s discuss the basics.

Provider Preference

Original Medicare allows its members to use any hospital or doctor that accepts Medicare. You don’t need referrals to see any medical provider. If you need extra coverage, you can enroll in a Medicare Supplement plan, which can provide coverage outside the United States, depending on the plan. 

Medicare Advantage is provided by private health insurers approved by Medicare. Most MA plans require you to have a primary care physician who would manage your care and require referrals for you to see a specialist. Some MA plans also limit healthcare services to be received only within their specific network for coverage to take effect.


While Medicare covers most of your medical needs, there are certain services the plan doesn’t pay for – such as cosmetic surgery or hearing, vision, and dental care. With Original Medicare, you get a wide variety of medical services, including doctor visits, hospitalization, outpatient care, and diagnostic tests.

On the other hand, Medicare Advantage plans allow you to get all the services provided by Original Medicare, as well as extra benefits not provided by Original Medicare. Some Medicare Advantage plans provide vision, hearing, and dental care. Some Medicare Advantage plans also provide gym memberships, transportation to doctors’ offices, and more.


If you have Original Medicare, you will pay premiums, deductibles, and coinsurance costs for Medicare Part A and Part B, unless you qualify for premium-free Part A. Beneficiaries who also choose to enroll in a Part D plan or Medicare Supplement plan will also pay out-of-pocket costs, although premiums, deductibles, and copays vary by plan.

With Medicare Advantage, some plans have a premium as low as $0, but you must still pay the Medicare Part B premium. However, instead of paying 20% coinsurance for doctor’s visits, most Medicare Advantage plans set a copay for a doctor’s visit, which usually results in lower out-of-pocket costs.

Health Conditions

Those with chronic health conditions such as chronic heart failure, cancer, or stroke will be affected by their medical coverage. While Medicare may not cover all your needs, a Medicare Advantage Special Needs Plan may help cover long-term costs. It can also help you save more money on certain medical needs, such as medical equipment and lab tests.

Finding a Medicare plan that covers all your health needs and is within your budget doesn’t have to be complicated. To make a well-informed decision, you can contact Generations Insurance and speak to an experienced Medicare expert.