Medically reviewed by Kelsey Mueckl, RN, BSN

If you’re new to Medicare, either because you’re turning 65 or a life circumstance has led you to this point, you may be wondering how to sort out all the facts well enough to make the right decision. At the beginning, it’s not easy. The good news is you’re not alone, and many good sources and organizations can help get you up to speed and gain knowledge.

In this blog, we’re going to help you understand the basic differences between Original Medicare and Medicare Advantage and learn which may sound like a better fit for you.

What are the basic parts of Medicare?

It’s natural to feel confused about Medicare programs, because the names are similar and there are many plans. You may hear conversations about parts A,B,C, and D, and with no prior knowledge or point of reference, you may not know what any of it means.¹

What is Original Medicare?

Original Medicare is Part A and Part B. Funded by the government, Original Medicare is highly flexible because you can go to any doctor or hospital in the U.S. that takes Medicare. It’s important to know there’s no coverage for drugs or prescriptions with Part A and Part B.

Part A – Hospital insurance: This covers inpatient hospital stays, short-term nursing facilities, hospice care, and some home health care. Part A is generally free if you’ve paid Medicare taxes for at least 10 years. If you haven’t, then a premium fee might apply in your case.

Part B – Medical insurance: This includes doctor visits, outpatient services, preventive care like flu shots, and some medical equipment.

People who choose Original Medicare may also decide to add a Medigap plan to help cover or fill in the coverage “gap” that may lead to more out-of-pocket expenses for deductibles, drugs, or other benefits.

Part C: Medicare Advantage plans

Medicare Advantage plans are plans offered by private insurance companies and are referred to as Part C. These plans are approved by Medicare. While it’s an alternative to Original Medicare, these plans offer extra benefits not covered by Parts A and B like drug coverage, vision, dental, and hearing. In 2025, more than half of the eligible Medicare population is enrolled in a Medicare Advantage plan, with the number to continue to rise.²

What’s important to know about Part C plans is they do have network restrictions, which limit the doctors you can see or the hospitals you may use. These all-in-one plans usually have many extra benefits, like dental or vision, but they may also come with an added cost.

Medicare plans are either HMOs which focus on care provided by in-network providers or by PPOs which offer greater flexibility out of network but may be more expensive.³

What is Part D?

Part D refers to prescription drug coverage. Part D can be a standalone plan to Parts A and B, or seniors can enroll in a Part C Medicare plan that offers Part D drug coverage as well. Note that not every Part C plan includes Part D coverage.

What’s the difference between Medicare and Medicare Advantage?

To understand the difference between Medicare and Medicare Advantage, think about two basic things:

• Who manages your plan or care
• How your benefits are delivered

Here’s a quick look again at Medicare Advantage vs. Medicare⁵:

How do I decide which is better for me?

Making a decision about a healthcare plan is important for anyone at any age. However, for seniors who may be retired or living on a fixed income, the choice may feel even more intimidating.

A good place to start is to simply consider your own personal health picture and budget, then decide what coverage best fits your needs. Some questions to ask yourself:⁴

• Are you generally healthy? Or do you have chronic conditions that require ongoing care and medications? Do you rarely see a doctor, or do you have a list of specialists?
• Do you travel a lot or infrequently? Or do you spend the seasons of the year in different places across the country?
• Do you take a lot of medications? Is this a large expense for your household budget?
• What’s your tolerance for referrals, dealing with networks, or network/plan restrictions?
• What is your overall budget? What are your current financial demands? Can you afford to handle higher monthly premiums, or do you need smaller out-of-pocket expenses?

If you’re just learning about Medicare, you may not know which plan is right for you. As you gain insight into how the plans are managed, who manages each plan, and what the key benefits are, you’ll begin to understand which one best fits your life and needs.

If you’re still feeling uncertain, visit with a Conviva senior primary care doctor or care team member.

Sources:

• “Parts of Medicare,” Medicare.gov, last accessed August 8, 2025,
   https://www.medicare.gov/basics/get-started-with-medicare/medicare-basics/parts-of-medicare
• “Medicare,” Kaiser Family Foundation, last accessed August 8, 2025, https://www.kff.org/medicare/
• “Medicare Advantage: A Policy Primer,” The Commonwealth Fund – Primer on Medicare Advantage, last accessed August 8, 2025 https://www.commonwealthfund.org/publications/explainer/2022/may/medicare-advantage-policy-primer
• “Medicare vs. Medicare Advantage: Which is right for you?”, U.S. News & World Report, last accessed August 8, 2025
  https://health.usnews.com/medicare/articles/medicare-vs-medicare-advantage-how-to-choose
• “Medicare Advantage vs. Original Medicare: Which Should You Trust Your Health To?”, Investopedia, last accessed August 8, 2025
   https://www.investopedia.com/medicare-advantage-vs-original-medicare-which-should-you-trust-your-health-to-11689475