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Reviewed for accuracy by Lauri Middleton, RN, MSN, licensed Medicare agent · Reviewed for clarity by Karen Orilla · · Meet our reviewers →
Decision 2 of 5
Original Medicare, or Medicare Advantage?
Do I assemble coverage from pieces, or take one bundled private plan?
What this is
Original Medicare is Part A and Part B from the government: any doctor in the country who accepts Medicare, and you pay 20 % of most services with no yearly cap — unless you add Medigap. Drug coverage is a separate Part D plan.
Medicare Advantage is a private plan that bundles A, B and usually D into one card, with a network of doctors and a yearly cap on what you pay for medical care. The plan premium is often low or none, but each visit has a copay and the plan can change every January.
Original MedicarePart A and Part B run by the federal government. Any doctor in the U.S. who accepts Medicare; you pay 20 % of most Part B services with no yearly cap unless you add Medigap. Glossary →Part C (Medicare Advantage)A private plan that bundles Part A and Part B, usually drug coverage, and often extras, into one card with a network and a yearly cap on what you pay for medical care. Glossary →NetworkThe doctors, hospitals and pharmacies a plan has contracts with. HMO plans generally cover only the network; PPO plans cover outside it at a higher cost. Glossary →Yearly cap (out-of-pocket maximum)The most a Medicare Advantage plan can make you pay for covered medical care in a year. Original Medicare has no cap on its own. Glossary →Medigap (Medicare Supplement)A private policy that pays some or most of the 20 % and other gaps in Original Medicare. Plans are standardized by letter (G, N and so on). It cannot be used with Medicare Advantage. Glossary →
Applied to your calendar
Draw a calendar first and this section will use the actual dates.
→Choosing Medicare Advantage first and switching to Original later can mean a company is no longer required to sell Medigap — it may ask health questions or decline, depending on the state.
→On Original Medicare without Medigap, a bad year has no cap: 20 % of a large bill is a large bill.
→On Medicare Advantage, a doctor leaving the network or a plan changing in January are real events; the yearly Open Enrollment is when you can respond.
Medigap has one six-month window with no health questions
It starts the first month you are 65 or older and enrolled in Part B. During those six months a company must sell you any Medigap policy it offers, at the same price as someone in good health. Outside it, rights vary by state.
Medicare Advantage members get one more change, January to March
Someone already in a Medicare Advantage plan can switch to another one, or go back to Original Medicare (and add a Part D plan), between January 1 and March 31. Only one change in that window.
