Medicare vs. Medicare Advantage: What’s Right for You?

Deciding between Original Medicare and a Medicare Advantage plan can feel like trying to solve a riddle with missing clues. Do you go traditional? Or opt for something more all-inclusive? The stakes are high—your health, your wallet, and your peace of mind are all in the balance. So how do you choose the right option?

Still Not Sure? Call Virginia Insurance Advisors. 📞 (804) 635-2475 — Amelia Court House, Virginia. Let our local insurance professional walk you through your choices. Whether you’re comparing Medicare and Medicare Advantage plans, reviewing Medigap policies, or exploring an alternative to Original Medicare, we'll guide you with clarity.

What Is Original Medicare?

Original Medicare, also called Medicare Parts A and B, is the long-standing, federally-run program on Medicare policy. It includes:

• Medicare Part A: Covers hospital stays, skilled nursing, and some home health services.

• Medicare Part B: Covers doctor visits, outpatient care, and preventive services.

This is your basic health coverage. But it's not as complete as it sounds.

What Original Medicare Covers

• Hospital stays

• Doctor visits

• Some preventive screenings

• Skilled nursing in certain situations

But here’s the rub—Original Medicare doesn’t cover routine dental, vision, hearing, or prescription drugs. That means you'll need a separate Part D plan or a Medigap policy to fill those gaps.

The Pros

• Freedom to see any provider in the United States that accepts Medicare

• No plan’s network restrictions

• Reliable, consistent coverage

The Cons

• No out-of-pocket limit

• Must pay deductibles, coinsurance, and the Part B premium

• Original Medicare doesn't cover extras like gym memberships or hearing aids

• You'll need to purchase a Medigap plan if you want more complete coverage

If you want flexibility and don't mind piecing things together, Medicare with a Medigap plan may be a solid choice.

What Is a Medicare Advantage Plan?

Think of Medicare Advantage as the bundled version. Also known as Part C, these plans are offered by private insurance companies that contract with Medicare. They combine Parts A and B, and usually include a Part D plan.

Many Medicare Advantage plans also toss in benefits like dental, vision, fitness programs, and transportation.

What Advantage Plans Provide

• All the benefits of Original Medicare

• Often include prescription drug coverage

• Plans also include extras like dental and wellness perks

• Most come with an annual out-of-pocket spending cap

But Heads Up...

• Plans often have plan’s network restrictions

• You may need prior authorization for services

• Out-of-network care can cost you big

• Not all advantage plans provide the same level of coverage

Choosing to join a Medicare Advantage plan means trading a bit of flexibility for potentially more benefits—and lower upfront costs.

The Difference Between Medicare and Medicare Advantage

This is where most people get stuck. The difference between Medicare and Medicare Advantage isn’t just about coverage—it’s about control, convenience, and cost.

Let’s compare Original Medicare to Advantage side-by-side.

Feature	Original Medicare	Medicare Advantage
Includes Part A & B	✅	✅
Includes Part D	❌ (join a separate Medicare drug plan)	✅ (Many Medicare Advantage plans include this)
Monthly Premium	Part B premium + Medigap + Part D	Usually just Part B premium
Out-of-Pocket Cap	❌	✅
Network Restrictions	❌	✅ (plan’s network)
Dental & Vision	❌	✅
Prescription Drugs	❌	✅
Travel Nationwide	✅	Limited

In short: Original Medicare vs Medicare Advantage comes down to freedom vs. bundled convenience.

Both have merit. It just depends on what matters more to you.

Who Can Enroll?

Most eligible Medicare beneficiaries can choose between Original Medicare or Medicare Advantage when first signed up for Medicare. You’ll typically be eligible if you:

• Are 65 or older

• Have paid Medicare taxes for at least 10 years

• Or qualify due to disability

You can also switch plans during open enrollment for Medicare or a special enrollment period.

Types of Medicare Advantage Plans

There’s not just one kind of Advantage plan. You’ve got choices, and that’s a good thing.

Types of Medicare Advantage Plans include:

• HMO (Health Maintenance Organization)

• PPO (Preferred Provider Organization)

• PFFS (Private Fee-for-Service)

• SNP (Special Needs Plans)

Each has different rules for referrals, networks, and out-of-pocket costs. These plans are offered by major insurance companies and vary by region.

Original Medicare Doesn’t Cover Everything

Here’s a fast reality check: Original Medicare doesn't cover many common needs like:

• Routine dental and vision

• Hearing aids

• Long-term care

• Overseas emergency care

• Most prescription drugs

That’s why folks often buy a Medigap supplement or join a Medicare Advantage plan that fills those gaps.

Is a Medicare Advantage Plan Right for You?

Ask yourself:

• Do I want an all-in-one health plan?

• Am I okay with using a plan’s network?

• Do I need prescription drug coverage included?

• Do I want added perks like dental or gym memberships?

For many, Advantage plans can also mean simpler coverage. For others, they may feel limiting.

Guide to Medicare Premiums, Costs, and Coverage

Let’s talk numbers. Whether you choose Original Medicare or a Medicare Advantage plan, there are costs you’ll want to track:

• Part B premium (everyone pays this—yes, even with Advantage)

• Deductibles and coinsurance

• Monthly premium for a Part D plan or Medigap

• Possible extra charges for dental or hearing under Advantage

Plans will cover your hospital and outpatient care differently. Be sure to read the fine print or speak with an advisor.

Keep in mind: Medicare doesn’t cover everything. That’s why understanding your options is critical.

 Choosing Between Medicare or Medicare Advantage

When choosing between Original Medicare vs Medicare Advantage, think about your needs—not just today, but in the years ahead.

If flexibility and provider freedom matter most, stick with Original Medicare and add a Medigap policy.

If convenience, bundled perks, and cost limits are your priorities, consider an Advantage plan.

Remember, many people switch plans as their needs change. And that’s totally okay.

Contact Us

Whether you’re new to Medicare, helping a loved one, or reviewing your options, our team at Virginia Insurance Advisors can help you with all your needs Call us today (804) 635-2475  for personalized help. We'll  compare plans, explain the difference between Medicare and Medicare Advantage, and help you make the best choice for your future. You’ve got choices. Make them with confidence.