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The Big Choice: Original Medicare vs. Medicare Advantage

Which path you take will determine how you get your medical care — and how much it costs

10-minute read

Article 2 of 10 in Medicare Parts

Tony Pugh and Kimberly Lankford,

Updated October 15, 2026

AARP

Reviewed by

Xavier Vaughn, MPH

En español

Updated October 15, 2026

Key takeaways

Original Medicare has many parts. Medicare Advantage is all-in-one.
Any doctor who accepts Medicare can be used in original Medicare.
Medicare Advantage coverage varies by plan for in-network, out-of-network providers.
Both must cover the same services, but costs differ between the two.
Original Medicare goes anywhere in U.S. Medicare Advantage has geographic limits.
Many states’ Medigap rules make it hard to leave Medicare Advantage.

Once you’re signed up for Medicare Parts A and B, you get to choose the type of coverage that best meets your needs — original Medicare or a Medicare Advantage plan.

If you decide on federally run original Medicare, you’ll have several separate pieces that work together:

Part A helps pay for inpatient hospital and skilled nursing care, some home care and end-of-life hospice care.
Part B covers doctors’ services, diagnostic screenings, durable medical equipment, lab tests, outpatient care and preventive services.
A separate Part D plan is available to purchase because original Medicare doesn’t cover prescription drugs that you pick up from pharmacies.
A Medicare supplement policy, better known as Medigap, also can be bought to help with Medicare’s deductibles and copayments.

If you choose a Medicare Advantage (MA) plan issued by commercial insurers, you may have Part A, Part B and Part D all in one plan. Nearly 90 percent of MA plans for individual enrollment include prescription drug coverage in 2026, according to KFF, a nonprofit, nonpartisan health care research organization.

As of June 2026, MA plans enrolled 51 percent — 36.1 million — of Medicare's 70.6 million beneficiaries.

If you select an MA plan, you’re not allowed to purchase a Medigap policy. MA plans have different copayments and deductibles, compared with original Medicare.

On average, Medicare beneficiaries can choose from 28 MA plans with prescription drug coverage in 2027, down from 32 options in 2026, KFF says.

Among all MA plans, including those with and without prescription drug coverage, the average beneficiary can choose from 35 plans in 2027, down from 39 in 2026, KFF says.

“There are trade-offs in choosing one kind of coverage over the other,” says Meredith Freed, a senior policy manager with KFF’s Program on Medicare Policy.

“A Medicare Advantage plan may have zero-dollar premiums, availability of extra benefits, reduced cost sharing for many services and an out-of-pocket spending limit,” Freed says. “Those things are attractive to people, but it also comes with provider networks and prior authorization.”

You’ll use Medicare differently depending on whether you pick original coverage or MA. Here’s a comparison of how each works.

The way you pay for your doctors could change

Original Medicare. You can choose any primary care doctor or specialist who accepts Medicare. You don’t need referrals to see any provider, and you don’t have to worry about your doctor leaving a plan’s network.

Only 2 percent of doctors who treat adults don’t participate in Medicare, according to KFF. So chances are good that your current doctor accepts Medicare and you won’t have to change providers.

But be aware: If you’re looking for a new doctor, about 1 in 7 primary care physicians won’t take new patients in general. That’s something to note if you plan to move or your doctor is retiring.

Medicare Advantage. Similar to employer coverage, with provider networks that limit you to their doctors, these plans may not pay for out-of-network services. So your costs will increase if you use a doctor not in the network.

Often, you’ll have a primary care physician coordinating your care, but many MA enrollees need a referral to see a specialist. Make sure the doctors you want to see are in the plan’s network.

Both Medicare options cover basics but vary on ‘extras’

By law, original Medicare and MA plans must both provide coverage for the same medical services, including blood work; diagnostic tests, such as X-rays and other scans; doctor visits; hospitalizations; and outpatient surgery.

Original Medicare. It won’t pay for routine dental, hearing and vision care.

Medicare Advantage. You can expect prior authorization requirements. Most MA plans provide some dental, hearing and vision care as supplemental benefits that are unavailable in original Medicare. Other MA supplemental benefits can include gym memberships, over-the-counter medications and, for some enrollees: pest control service, utility bill assistance and transportation to the doctor’s office.

Your costs: original Medicare vs. Medicare Advantage

Even though original Medicare and MA must cover the same Part A and Part B services, you may have different out-of-pocket costs.

Original Medicare. The federal government sets Medicare premiums, deductibles and coinsurance amounts for Part A and Part B. For example, you’re responsible for 20 percent of a doctor visit or lab test bill under Part B.

Most people don’t pay a premium for Part A because they or their spouse paid Medicare taxes for at least 10 years. But they do pay Part B premiums. The standard amount is $202.90 a month for most people in 2026; high earners pay more.

Often, those with original Medicare also purchase a supplemental Medigap policy to help defray out-of-pocket costs. While original Medicare doesn’t have an annual cap on out-of-pocket costs, a Medigap policy may pay for most of your deductibles, copayments and Part A and Part B coinsurance.

AARP Audio · Does Medigap Cover Preexisting Conditions?

Medicare Advantage. You’ll still pay the government-set annual Part B premium and the Part A premium, if required. Sometimes you’ll pay an additional premium for the MA plan, although 75 percent of enrollees in MA plans with prescription drug coverage pay no additional premiums, according to KFF.

But instead of paying the 20 percent coinsurance for doctor visits and other Part B services, most MA plans have set copay amounts for a physician visit, such as $20 or $50.

MA plans have an annual maximum cap on out-of-pocket expenses. In 2026, it’s $9,250 for in-network services and $13,900 for in-network and out-of-network services combined. For 2027, it’s $9,850 for in-network services and $14,800 for in-network and out-of-network services combined. Plans typically set their own spending caps.

And don’t forget: Whether you have Part D coverage in original Medicare or MA, your out-of-pocket costs, which are capped at $2,100 in 2026, will rise to $2,400 in 2027. After you reach that spending limit, you’ll pay $0 for your Part D–covered medications for the rest of the year.

Where you live and travel matters

Original Medicare. You can access care anywhere in the United States as long as the provider accepts Medicare.

Medicare Advantage. Plans are based around provider networks that are usually limited to specific geographic areas.

So if you travel a lot or have a vacation home where you spend time, your care may not be covered if you go to an out-of-network provider — or you’ll pay more for care. Emergency and some urgent care are covered if you’re traveling within the U.S.

While MA plans are available pretty much throughout the U.S., the choice of plans is more limited in rural areas.

Neither original Medicare nor MA pays for your health care abroad.

Why switching back and forth is difficult

You aren’t locked into the choice between original Medicare and MA that you make when you first enroll in the program. And going from original Medicare to MA is easy. You can do so during Medicare’s annual open enrollment season, Oct. 15 to Dec. 7.

However, switching from MA to original Medicare can be trickier.

The reason? Medigap. When you first enroll in Medicare — either in your seven-month initial enrollment period or a six-month Medigap open enrollment period that starts the first month you’re 65 and have Medicare Part B — you can buy any Medigap policy available in your state, no matter your health. And it likely will be cheaper than you’ll ever find later.

In most states, Medigap open enrollment is a once-in-a-lifetime opportunity that you have when you choose original Medicare. If you decide to switch to original Medicare later, Medigap insurers can reject you or charge you more because of preexisting conditions, or delay your coverage after you’re accepted.

Only six states. Connecticut, Maine, Massachusetts, Minnesota, New York and Rhode Island require insurers to offer — either continuously or during an annual open enrollment period — at least one Medigap policy on a guaranteed-issue basis, meaning without being subject to medical underwriting.

Original Medicare enrollees who aren’t accepted into a Medigap plan — or other form of supplemental coverage, like a retiree health plan from a former employer — face no limit on potential medical expenses they could owe. With a MA plan, the most you would pay in 2026 is the $9,250 out-of-pocket limit on in-network services or the $13,900 limit on in- and out-of-network services. Those limits go to $9,850 and $14,800 in 2027.

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This story, originally published July 1, 2020, has been updated to reflect the most current information for 2027 and to add a section about the difficulties of buying a Medigap policy after you’re first eligible.

About the authors

Tony Pugh is an award-winning writer and editor covering Medicare for AARP. He has also covered Medicare for Bloomberg Law and as a national correspondent for Knight Ridder/McClatchy Newspapers.

Kimberly Lankford is a contributing writer who covers Medicare and personal finance. She wrote about insurance, Medicare, retirement and taxes for more than 20 years at Kiplinger’s Personal Finance and has written for The Washington Post and The Boston Globe. She received the personal finance Best in Business award from the Society of American Business Editors and Writers and the New York State Society of Certified Public Accountants’ excellence in financial journalism award for her guide to Medicare.

About the reviewer

Xavier Vaughn, an AARP adviser for Medicare programs, previously worked at the National Council on Aging in Arlington, Virginia, and the Primaris Foundation, based in Columbia, Missouri. He earned his master’s degree in public health from the University of Alabama at Birmingham.