Original Medicare vs. Medicare Advantage: What Retirees Need to Know
- Marc Lowe
- Jul 10
- 5 min read
Updated: Jul 14
One of the most common questions I get from clients approaching retirement is this:
“What’s the difference between Original Medicare and Medicare Advantage?”
And it’s a great question—because while both are part of the Medicare system, they operate very differently. Unfortunately, there’s a lot of confusion around this topic, and understanding the trade-offs between the two is critical for making informed healthcare decisions in retirement.
Let’s clear things up.
What Is Original Medicare?
Original Medicare is the traditional government-run health insurance program for Americans age 65 and older. It’s been around since the 1960s and includes:
Part A: Hospital insurance (covers inpatient hospital stays, skilled nursing facilities, hospice, and some home healthcare)
Part B: Medical insurance (covers doctor visits, outpatient care, medical supplies, and preventive services)
When you enroll in Original Medicare, you’re getting your coverage directly from the federal government.
Key Benefit: No Prior Authorizations
One of the biggest advantages of Original Medicare is this: you don’t need prior authorization for most services.
That might sound like a small detail, but it’s a big deal—especially as our healthcare system becomes more strained. We’re currently facing a nationwide shortage of nurses, doctors, and healthcare workers. That means more delays and more red tape for patients—especially when private insurers are involved.
With Original Medicare, your doctor can make medical decisions without having to wait for approval from an insurance company. Need a test? A surgery? An urgent procedure? You just get it done.
No insurance company in the middle. No waiting weeks for a green light. That peace of mind can be life-saving.
What About Medicare Advantage?
Medicare Advantage (also known as Part C) is a privatized alternative to Original Medicare. These plans are offered by private insurance companies approved by Medicare.
When you join a Medicare Advantage plan, you’re no longer using government-run insurance. Instead, you get all your services—including Part A, Part B, and often Part D prescription drug coverage—through a private health insurance company.
These plans often include extra benefits like:
Dental
Vision
Hearing
Gym memberships
Over-the-counter reimbursements
Sounds great, right?
Well, there’s a catch.
Prior Authorizations Are Required
With Medicare Advantage, you almost always need prior authorization for non-emergency procedures and services. That means your doctor has to get approval from the insurance company before moving forward with care.
This can lead to delays—sometimes weeks or even months.
And for retirees, especially as they age into their late 70s and 80s, time matters. A delay in surgery, imaging, or treatment could have serious health consequences.
In fact, recent studies have shown that prior authorization requirements under Medicare Advantage plans have led to higher rates of care denials—and in some cases, those denials have resulted in avoidable hospitalizations.
What Doesn’t Medicare Cover?
Whether you choose Original Medicare or Medicare Advantage, it’s important to know that neither option covers long-term care.
This includes:
Nursing home care (custodial care)
Assisted living facilities
Extended home care for help with bathing, dressing, and other daily needs
If long-term care is a concern (and for many retirees, it should be), you'll want to explore separate planning strategies—such as long-term care insurance or Medicaid planning.
The Role of Medigap with Original Medicare
One of the biggest perks of sticking with Original Medicare is the ability to pair it with a Medigap policy.
Medigap is supplemental insurance designed to cover some of the out-of-pocket costs that Original Medicare doesn’t, such as:
Deductibles
Copayments
Coinsurance
Emergency medical care when traveling abroad
Some Medigap plans also cap your annual out-of-pocket costs—something that Original Medicare doesn’t do on its own.
This combination (Original Medicare + Medigap) offers predictable costs, freedom to see any provider that accepts Medicare, and global coverage for emergencies. For retirees who plan to travel or want maximum flexibility, this can be a strong advantage.
Medicare Advantage: The “All-in-One” Plan
If you like the idea of simplicity and want everything bundled—including drug coverage and dental/vision/hearing—then Medicare Advantage might seem more attractive.
You pay one premium to one private company. You get all your coverage in one place. And in many cases, the monthly premium can be lower than a Medigap policy.
But remember: you’re trading flexibility for convenience.
With most Medicare Advantage plans, you’re working within a network of doctors and hospitals. And if you go out-of-network, your care may not be covered, or you’ll pay more.
Enrollment Timing Matters
If you decide to go with Original Medicare, here’s what the timeline looks like:
You can enroll in Medicare Parts A and B starting three months before your 65th birthday.
Once you’re enrolled in A and B and receive your Medicare card, you can apply for a Medigap policy through private insurance carriers.
Medigap has its own open enrollment window (typically six months after you turn 65 and enroll in Part B), and during that time you can’t be denied coverage or charged more based on health conditions.
With Medicare Advantage, the enrollment process is simpler—you pick a plan during the Annual Enrollment Period (October 15 – December 7) or when you first become eligible.
Final Thoughts: Choose What Fits You
There’s no one-size-fits-all answer when it comes to Medicare.
If you value freedom of choice, fewer delays, and predictable costs, Original Medicare with a Medigap policy may be the way to go.
If you want lower premiums, bundled extras like dental and vision, and don’t mind working within a network, Medicare Advantage could make more sense.
But whatever you choose, the key is making a decision that aligns with your health needs, your retirement lifestyle, and your long-term care plans.
Have questions? That’s what I’m here for.
Ready to Make Sense of Medicare?
Whether you’re already enrolled or approaching age 65, we can help you understand your options, weigh the pros and cons, and integrate your healthcare decisions into your retirement plan.
About The Author
Marc Lowe is the Founder & President of In The Money Retirement Planning. He is a Certified Financial Planner and member of NAPFA National Association of Personal Financial Advisors, XY Planning Network & Fee-Only Network. He works with retirees and those approaching retirement. He has over a decade of experience helping these folks grow their net worth, organize their finances and build better lives for themselves and their families.
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