Original Medicare vs Medicare Advantage: What Are the Differences?

Updated on September 7, 2016

N0912P33009CSo, you’ve been researching Medicare. You’re 65 years old, or soon to be turning 65, and you’ve paid Social Security tax for at least 10 years. Now Medicare should start automatically, but will it cover everything you need? You might be overwhelmed with information on Original Medicare and Medicare Advantage. What you really need are simple definitions and a basic overview explaining the differences with each.

If you just started your research on Original Medicare vs Medicare Advantage, great! Let’s free up your time by walking you through some key points you will need to consider. If you’re looking for more details, download our Complete Guide to Planning your Healthcare for Retirement.

Age and Open Enrollment

As we mentioned above, if you’re 65 years old, or soon to be turning 65, now is the time to look into your Medicare options. If you’re older than 65, Open Enrollment (October 15th to December 7th) is the time you can make changes to your current Medicare Advantage or Part D plan, should you have one. While this may all seem very overwhelming, and assuming you’re not looking to spend the rest of your golden years doing research, we invite you to call My Senior Health Plan to speak with someone who can quickly walk you through your Medicare options.

Coverage: Vision, Dental, Prescriptions (Plan D), and Assisted Living or Nursing Home Care

When considering which plan is right for you, coverage can help you quickly narrow your choices down. Let’s review how to best solve the Medicare vs Medicare Advantage dilemma.


First up, vision! Since you are reading this, we can only assume you either have great eyes or great glasses. If you have great eyes, this section shouldn’t concern you that much. However, if you’re like many of us and have great glasses, vision coverage is something you’re going to want to take into serious consideration. Original Medicare does not cover vision, however Medicare Advantage does. Vision is handled by private insurance companies.


For dental coverage, the ideal option is Medicare Advantage due to Original Medicare’s lack of service coverage. For a complete breakdown of service coverage for each, check out the table below:

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Prescriptions are not automatically covered by Original Medicare. You are required to buy into what is called ‘Plan D’ in order to receive coverage. Medicare Advantage, on the other hand, can include coverage for prescriptions.

That wraps up the basics on coverage differences with Medicare vs Medicare Advantage. Should you want more details, download our Complete Guide to Planning your Healthcare for Retirement.

Let’s move onto something more personal; considerations you should make for how you plan on living.

Assisted Living

Though not something many of us want to have to consider, at some point in our lives, we may require the assistance of others for our basic, daily needs. Unfortunately, Medicare does not cover assisted living or nursing home care, which means you or your family could end up incurring some steep costs the older you get. Medicare Advantage, on the other hand, can be customized to cover assisted living or nursing home care.

Availability of Care

To further narrow down your choice between Original Medicare vs Medicare Advantage, let’s discuss where and how you plan to receive care. With Medicare, you’re offered care across the country, with the ability to see any provider as long as they accept Medicare. Medicare also allows you to see any specialist without a referral.

Alternatively, Medicare Advantage works much like the insurance you may have now; i.e. you have a network of doctors and providers that you can see. Some plans also require a referral from your health provider before you can see a specialist.

While you won’t have the go anywhere, see anyone freedom you have with Original Medicare, Medicare Advantage can be customized to accommodate your lifestyle.


Your budget will become increasingly important during your retirement, especially if you are on a fixed income. This could very well be the decision-maker for you in the Medicare vs Medicare Advantage selection process.

Original Medicare deals with deductibles, which are usually 20% of the cost of medical service (according to medicarerights.org). This means the occasional check-up won’t end up costing too much. However, higher-cost services, such as hospitalizations, can cost over $10,000 easily depending on services and medication.

Medicare Advantage is required by law to cap their costs. Your out-of-pocket cost may not go over $6,700 a year, according to health.usnews.com. This cap helps to protect you from higher costs, should you need any serious medical attention.

Learn More

The Original Medicare vs Medicare Advantage debate is finally over! Just a quick read and we’ve touched on all of the major differences that you need to consider when making your selection. If this wasn’t enough and you’re still hungry for more information, download our Complete Guide to Planning your Healthcare for Retirement. Take care of yourself and enjoy the best years of your life! 

Kelsey is the Director of Marketing for My Senior Health Plan in San Diego. My Senior Health Plan is company whose primary focus is providing seniors with health insurance plans and insurance counseling. Their specialty is Medicare plans. Learn more about senior health insurance at My Senior Health Plan.


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