Turning 65? Here's the Difference Between Original Medicare and Medicare Advantage (In Plain English)

If you're about to turn 65, chances are you've been hearing a lot about Medicare—and maybe feeling a little overwhelmed by all the options. You're not alone!

One of the biggest decisions you'll face is choosing between Original Medicare and a Medicare Advantage plan. Both help cover your healthcare costs, but they work in different ways. Don’t worry—we’ll break it down so it’s easy to understand.

First, What Is Original Medicare?

Original Medicare is the traditional program offered by the federal government. It comes in two parts:

• Part A: Hospital coverage (inpatient care, nursing facility stays, hospice)

• Part B: Medical coverage (doctor visits, outpatient care, preventive services)

With Original Medicare, you can see any doctor or specialist who accepts Medicare, anywhere in the U.S. There's no network, and referrals aren’t usually needed.

✅ Pros:

• Freedom to choose any Medicare-accepting provider

• Simple, straightforward structure

• Great for frequent travelers or snowbirds

🚫 Cons:

• Doesn’t cover everything (like dental, vision, hearing, or prescriptions)

• You’ll usually pay 20% of most medical costs after a deductible (there's no out-of-pocket cap unless you add a Medigap policy)

• You’ll need to buy a separate Part D plan for prescriptions, and possibly a Medigap plan for extra coverage

What About Medicare Advantage?

Medicare Advantage (also called Part C) is offered by private insurance companies approved by Medicare. These plans combine Part A, Part B, and usually Part D (prescription drug coverage) into one plan. Many also include extras like dental, vision, hearing, and even fitness programs.

But there’s a catch: most Medicare Advantage plans have networks, like an HMO or PPO. So you may need to pick doctors in the plan and get referrals to see specialists.

✅ Pros:

• All-in-one coverage, often with extras

• Monthly premiums can be low or even $0 (though you still pay your Part B premium)

• Most plans include drug coverage

🚫 Cons:

• You may need to stay in-network

• Can involve more rules (like prior authorizations)

• Less flexibility if you travel often or split time in different states

So… Which One Is Better?

That depends on you.

If you want maximum flexibility to see any doctor and don’t mind paying a bit more for a Medigap plan to fill the gaps, Original Medicare might be your best fit.

If you prefer convenience, like the idea of everything bundled into one plan, and don’t mind networks, Medicare Advantage could be a better match.

One Last Tip

Whether you go with Original Medicare or Medicare Advantage, it’s smart to compare your options every year during the open enrollment period. Your health needs can change—and so can the plans.

Still feeling unsure? That’s totally normal. Talking to a licensed Medicare advisor or using the official Medicare.gov Plan Finder can help you make the best choice for your situation.

Turning 65 doesn’t have to be confusing—just take it one step at a time. You’ve got this!

Would you like help Call Kursti 757-692-8438