Compare Your Options

Original Medicare vs. Medicare Advantage vs. Medicare Supplement Plans

Once you understand the basic parts of Medicare, the next question is usually:

How do I want to receive my Medicare coverage?

Most people compare two main coverage paths:

  1. Original Medicare

  2. Medicare Advantage

A Medicare Supplement plan, also called Medigap, is not a replacement for Original Medicare. It is optional private insurance that can work with Original Medicare to help pay some out-of-pocket costs. After you sign up for Part A and Part B, you can choose how you want to get your health coverage, and the two main paths are Original Medicare and Medicare Advantage.

This page will help you compare the major Medicare coverage options, understand where Part D prescription drug coverage fits in, and learn what questions to ask before making a decision.

This page is educational only. We do not recommend any specific plan, insurance company, premium, benefit, or coverage choice.

The Big Picture

Medicare coverage can feel complicated because people often compare several things at once.

Here is the simplest way to organize it:

Path 1:
Original Medicare
Part A + Part B

Optional additions:
- Part D prescription drug plan
- Medicare Supplement Insurance, also called Medigap
Path 2:
Medicare Advantage
Part C

Usually includes:
- Part A
- Part B
- Often Part D prescription drug coverage

The most important thing to remember:

Medigap works with Original Medicare. Medicare Advantage is a different way to receive your Medicare benefits.

Medicare.gov explains that Original Medicare includes Part A and Part B, while Medicare Advantage is a Medicare-approved private plan that offers an alternative to Original Medicare.

Option 1: Original Medicare

Original Medicare is the traditional way to receive Medicare.

It includes:

  • Medicare Part A — hospital insurance

  • Medicare Part B — medical insurance

With Original Medicare, Medicare pays part of the cost when you receive a covered service, and you pay your share. Medicare.gov explains that with Original Medicare, you can use any doctor or hospital that accepts Medicare anywhere in the United States.

Original Medicare may appeal to people who want broad access to Medicare-accepting doctors and hospitals.

What Original Medicare Includes

Original Medicare includes Part A and Part B.

Part A helps cover certain inpatient hospital care, skilled nursing facility care, hospice care, and some home health care.

Part B helps cover doctor visits, outpatient care, preventive services, diagnostic tests, durable medical equipment, and other medically necessary services.

Original Medicare covers many medically necessary services and supplies in hospitals, doctors’ offices, and other healthcare settings. However, Medicare.gov explains that Original Medicare does not cover every service, such as most dental care, routine eye exams, and routine physical exams.

What Original Medicare Does Not Automatically Include

Original Medicare does not automatically include most outpatient prescription drug coverage.

If you choose Original Medicare and want prescription drug coverage, you can usually add a separate Medicare Part D drug plan. Medicare.gov explains that Part D plans can add Medicare drug coverage to Original Medicare.

Original Medicare also does not include a built-in yearly limit on what you pay out of pocket unless you have supplemental coverage, such as Medigap, Medicaid, employer coverage, retiree coverage, union coverage, or Medicare Advantage.

That is one reason many people who choose Original Medicare also consider Medigap.

Option 2: Original Medicare With a Medicare Supplement Plan

A Medicare Supplement plan, also called Medigap, is optional private insurance that works with Original Medicare.

Medigap can help pay some of your share of costs in Original Medicare, such as copayments, coinsurance, and deductibles. Medicare.gov explains that Medigap is extra insurance you can buy from a private company to help pay your share of costs in Original Medicare.

A simple way to remember it:

Original Medicare pays first. Medigap may help pay some remaining approved costs.

Medigap does not replace Medicare. It supplements Original Medicare.

How Medigap Works

To buy a Medigap policy, you generally must have Original Medicare, which means you have Medicare Part A and Medicare Part B. Medicare.gov explains that you generally must have Part A and Part B to buy a Medigap policy.

When you receive Medicare-covered care, Medicare generally pays its share first. Then your Medigap policy may pay some or all of the remaining amount you owe, depending on the policy.

Medigap can help make some Original Medicare costs more predictable, but it usually has a separate monthly premium.

What Medigap Does Not Cover

Medigap does not cover everything.

Medicare.gov explains that Medigap policies generally do not cover long-term care, routine vision or dental care, hearing aids, eyeglasses, private-duty nursing, or prescription drugs.

That means if you choose Original Medicare with Medigap and want prescription drug coverage, you will usually also need to consider a separate Part D plan.

A simple way to think about it:

Original Medicare = Part A + Part B

Medigap = helps with some Original Medicare out-of-pocket costs

Part D = helps with prescription drugs

Option 3: Medicare Advantage

Medicare Advantage is also called Medicare Part C.

It is another way to receive your Medicare coverage through a Medicare-approved private insurance company. Medicare.gov explains that Medicare Advantage plans are offered by private companies and serve as an alternative to Original Medicare for health and drug coverage.

To join a Medicare Advantage plan, you must have both Part A and Part B. Medicare.gov also explains that Medicare Advantage generally includes Part A and Part B, and most plans include Part D prescription drug coverage.

A simple way to remember it:

Medicare Advantage is another way to receive your Medicare benefits through a Medicare-approved private plan.

You are still in Medicare if you choose Medicare Advantage.

How Medicare Advantage Works

Medicare Advantage plans must cover almost all medically necessary services that Original Medicare covers. Plans may also offer additional benefits that Original Medicare does not cover.

However, the way you receive care may be different.

With Medicare Advantage, you may need to use doctors and other providers in the plan’s network and service area for non-emergency care. Some plans may offer out-of-network coverage, but typically at a higher cost.

Some Medicare Advantage plans may also require:

  • Referrals to see specialists

  • Prior authorization before certain services are covered

  • Use of specific provider networks

  • Use of specific pharmacies

  • Care within a plan’s service area

These rules can vary by plan.

Medicare Advantage and Medigap Do Not Work Together

This is one of the most important Medicare rules to understand.

You generally cannot have Medicare Advantage and Medigap at the same time.

Medicare.gov explains that when you are getting started with Medicare, you can either buy Medigap or enroll in a Medicare Advantage plan, but you cannot have both. You also cannot use Medigap to pay Medicare Advantage copayments, deductibles, or premiums.

A simple way to compare the paths:

Original Medicare Path:
Part A + Part B
Optional Medigap
Optional Part D
Medicare Advantage Path:
Part C
Usually includes Part A, Part B, and Part D
No Medigap

This is not about which path is better. It is about understanding that the two structures work differently.

Where Part D Fits In

Part D is Medicare prescription drug coverage.

Where Part D fits depends on which Medicare path you choose.

If You Choose Original Medicare

If you choose Original Medicare and want drug coverage, you can generally add a separate Medicare Part D drug plan. Medicare.gov explains that a separate Medicare drug plan can add drug coverage to Original Medicare.

If You Choose Original Medicare With Medigap

Medigap does not usually include prescription drug coverage. So if you choose Original Medicare with a Medigap policy and want drug coverage, you will usually consider a separate Part D drug plan.

If You Choose Medicare Advantage

Most Medicare Advantage plans include Part D prescription drug coverage. Medicare.gov explains that with a Medicare Advantage plan that includes drug coverage, you usually get Part A, Part B, and Part D through one plan.

You should be careful before adding a separate Part D plan to Medicare Advantage. Medicare.gov explains that if you are in an HMO, HMO Point-of-Service plan, or PPO and join a separate drug plan, you will be disenrolled from your Medicare Advantage plan and returned to Original Medicare.

Comparing Costs

Cost is one of the biggest differences between these options.

With Original Medicare, you generally pay the Part B premium and usually 20% of the Medicare-approved amount for many Part B-covered services after meeting the deductible. If you add a Part D plan, you may pay a separate premium for drug coverage.

With Medicare Advantage, you still pay the Part B premium and may also pay a plan premium depending on the plan. Out-of-pocket costs can vary by plan and service, but Medicare Advantage plans include a yearly limit on what you pay for covered Medicare services.

With Medigap, you pay a separate premium to the private insurance company. In exchange, the policy may help pay some of your share of Original Medicare costs, depending on the policy.

A simple way to think about it:

Original Medicare:
Flexible provider access, but no built-in yearly out-of-pocket cap by itself.

Original Medicare + Medigap:
Adds a premium, but may reduce certain out-of-pocket costs.

Medicare Advantage:
May have plan rules and networks, but includes an annual out-of-pocket limit for covered Medicare services.

Comparing Doctor and Hospital Access

Doctor and hospital access is one of the most important things to compare.

With Original Medicare, you can generally use any doctor or hospital that accepts Medicare anywhere in the United States.

With Medicare Advantage, you may need to use doctors, hospitals, and other providers in the plan’s network and service area for non-emergency care. Some plans may offer out-of-network coverage, usually at a higher cost.

Because Medigap works with Original Medicare, it generally pairs with Original Medicare’s provider access. However, some Medigap policies, such as Medicare SELECT policies, may have provider rules.

Questions to ask:

  • Do my doctors accept Original Medicare?

  • Are my doctors in the Medicare Advantage plan’s network?

  • Are my preferred hospitals in network?

  • What happens if I travel?

  • What happens if I live part of the year in another state?

  • What happens if my doctor leaves the network?

Comparing Prescription Drug Coverage

Prescription drug coverage is a major part of the decision.

With Original Medicare, drug coverage is not automatically included. If you want drug coverage, you can generally join a separate Part D plan.

With Medigap, drug coverage is still separate. Medigap policies generally do not cover prescription drugs.

With Medicare Advantage, most plans include Part D prescription drug coverage. In many Medicare Advantage plan types, you generally do not add a separate Part D plan.

Before choosing coverage, ask:

  • Are my prescriptions covered?

  • What tier is each medication on?

  • Is my pharmacy in network?

  • Is my pharmacy preferred?

  • What are my estimated yearly drug costs?

  • Does the plan have prior authorization, step therapy, or quantity limits?

Part D should never be an afterthought.

Common Coverage Paths

Here are the common structures people compare.

Path 1: Original Medicare Alone

This includes Part A and Part B.

You may add Part D if you want prescription drug coverage.

This path offers broad provider access, but Original Medicare alone does not include a built-in yearly out-of-pocket maximum.

Path 2: Original Medicare + Part D

This includes:

  • Part A

  • Part B

  • Separate Part D drug plan

This path may be considered by people who want Original Medicare and prescription drug coverage, but do not add Medigap.

Path 3: Original Medicare + Medigap + Part D

This includes:

  • Part A

  • Part B

  • Medicare Supplement Insurance, also called Medigap

  • Separate Part D drug plan

This path may be considered by people who want Original Medicare, prescription drug coverage, and help paying some Original Medicare out-of-pocket costs.

Path 4: Medicare Advantage

This usually includes:

  • Part A

  • Part B

  • Often Part D

This path may be considered by people who want coverage organized through a Medicare-approved private plan and are comfortable reviewing provider networks, drug coverage, costs, and plan rules.

Original Medicare May Be Worth Understanding If…

Original Medicare may be worth a close look if you want broad access to doctors and hospitals that accept Medicare, travel often within the United States, or prefer not to use a local provider network.

It may also be worth understanding if you are considering adding Medigap and Part D for a more complete Original Medicare coverage path.

Remember, Original Medicare alone does not include most outpatient prescription drug coverage or a built-in yearly out-of-pocket maximum.

Medicare Advantage May Be Worth Understanding If…

Medicare Advantage may be worth a close look if you want coverage organized through one Medicare-approved private plan and are comfortable reviewing networks, service areas, referrals, prior authorization rules, and plan-specific costs.

Many Medicare Advantage plans include Part D prescription drug coverage, and plans have a yearly limit on what you pay for covered Medicare services.

However, plan details can vary by county, company, year, doctors, hospitals, pharmacies, and prescription drugs.

Medigap May Be Worth Understanding If…

Medigap may be worth a close look if you choose Original Medicare and want help paying some Original Medicare out-of-pocket costs.

Medigap policies are standardized in most states, and policies with the same letter offer the same basic benefits no matter which company sells them.

However, Medigap usually has a separate monthly premium, generally does not include prescription drug coverage, and does not work with Medicare Advantage.

Part D May Be Worth Understanding No Matter Which Path You Choose

Prescription drug coverage is important because your medications can affect both your health and your budget.

If you choose Original Medicare, you can generally add a separate Part D plan.

If you choose Original Medicare with Medigap, you will usually still need a separate Part D plan if you want drug coverage.

If you choose Medicare Advantage, you will often receive drug coverage through the Medicare Advantage plan itself.

Part D plans can vary by formulary, pharmacy network, drug tiers, premiums, deductibles, and plan rules. Even if two people choose the same Medicare path, their best drug coverage questions may be very different because their medications may be different.

Questions to Ask Before Comparing Options

Before comparing Medicare options, gather your personal information.

Ask yourself:

  • Do I want broad doctor and hospital access?

  • Do my doctors accept Original Medicare?

  • Are my doctors in any Medicare Advantage plan networks I am considering?

  • Do I travel often?

  • Do I live in more than one state during the year?

  • What prescriptions do I take?

  • Are my medications covered?

  • Which pharmacies do I use?

  • Do I want to consider Medigap?

  • Am I in my Medigap Open Enrollment Period?

  • What monthly premiums can I afford?

  • What out-of-pocket costs could I face?

  • Am I comfortable with referrals or prior authorization?

  • Do I want coverage organized through one plan?

These questions help you compare Medicare options based on your situation instead of choosing based on general opinions.

Common Misunderstandings

“Medigap is a third way to get Medicare.”

Not exactly. Medigap is not a standalone replacement for Original Medicare or Medicare Advantage. It is supplemental insurance that works with Original Medicare.

“Medicare Advantage replaces Medicare.”

No. Medicare Advantage is part of Medicare. It is another way to receive your Medicare benefits through a Medicare-approved private plan.

“Original Medicare automatically includes drug coverage.”

Usually no. Original Medicare does not automatically include most outpatient prescription drug coverage. If you want drug coverage, you can usually add a separate Part D plan.

“I can have Medicare Advantage and Medigap together.”

No. Medicare.gov explains that you cannot have both Medicare Advantage and Medigap at the same time.

“All Medicare Advantage plans work the same way.”

No. Medicare Advantage plans can vary by network, cost, prior authorization rules, prescription drug coverage, service area, and plan type.

“All Medigap policies are totally different.”

In most states, Medigap policies are standardized by letter. The basic benefits for the same lettered plan are the same regardless of which company sells it, although price can vary.

Common Questions About Comparing Medicare Options

Is Original Medicare better than Medicare Advantage?

Not automatically. Original Medicare and Medicare Advantage are different ways to receive Medicare coverage. The better fit depends on your doctors, prescriptions, budget, travel habits, location, and healthcare needs.

Is Medigap better than Medicare Advantage?

Medigap and Medicare Advantage work differently. Medigap supplements Original Medicare, while Medicare Advantage is an alternative way to receive Medicare coverage. You generally cannot have both at the same time.

Do I need Part D if I choose Original Medicare?

If you choose Original Medicare and want prescription drug coverage, you can generally add a separate Part D plan. Medicare.gov explains that separate Part D plans can add drug coverage to Original Medicare.

Do I need Part D if I choose Medicare Advantage?

Many Medicare Advantage plans include Part D drug coverage, so you usually receive drug coverage through the plan. In some Medicare Advantage plan types, joining a separate Part D plan can cause you to be disenrolled from your Medicare Advantage plan and returned to Original Medicare.

Can I add Medigap later?

Maybe, but it may not be guaranteed. Your Medigap Open Enrollment Period is usually the best time to buy a Medigap policy. After that, you may have fewer options, may pay more, or may be denied based on medical underwriting unless you have certain protections.

What is the simplest way to compare options?

Start by comparing the two main paths: Original Medicare and Medicare Advantage. If you are considering Original Medicare, then compare whether adding Part D and Medigap makes sense for your situation.

The Simple Takeaway

There are two main ways to receive Medicare coverage:

Original Medicare

or

Medicare Advantage

If you choose Original Medicare, you may also consider adding:

  • Part D for prescription drug coverage

  • Medigap to help pay some Original Medicare out-of-pocket costs

If you choose Medicare Advantage, you usually receive your Medicare-covered services through a Medicare-approved private plan, and many plans include Part D prescription drug coverage.

The right choice is not the same for everyone.

A better question than “Which option is best?” is:

Which Medicare coverage path fits my doctors, prescriptions, budget, travel habits, location, and healthcare needs?

Need Help Comparing Your Medicare Options?

Comparing Original Medicare, Medicare Advantage, Medigap, and Part D can feel overwhelming because each option works differently.

If you are trying to understand which path may fit your situation, we can help connect you with a licensed Medicare professional who can answer questions based on your needs.

Get Medicare help when you’re ready.