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SummerOnTheWay1
SummerOnTheWay1
September 12, 2025

📋 Comparing Original Medicare vs. Medicare Advantage (AARP Article/Updated)

  • September 12, 2025
  • 5 replies
  • 5709 views

FROM THE ARTICLE.

 

The Big Choice: Original Medicare vs. Medicare Advantage.

Which path you take will determine how you get your medical care — and how much it costs.

 

By Dena Bunis and Kimberly Lankford, AARP. Reviewed by Xavier Vaughn, MPH.

Published July 01, 2020.

➡️[*** Updated September 08, 2025.

 

Key takeaways!

[*] Original Medicare has many parts. Medicare Advantage is all-in-one.

[*] Original Medicare lets you use any doctor. MA is more limited. ​

[*] Both must provide same care. MA costs differ from original Medicare.

[*] Original Medicare goes anywhere in U.S. MA has geographic limits.

[*] Many states’ Medigap rules make leaving Medicare Advantage hard.

 

USE LINK BELOW TO READ THE ARTICLE.

 

https://www.aarp.org/medicare/original-medicare-vs-advantage/

    5 replies

    SummerOnTheWay1
    SummerOnTheWay1Author
    September 12, 2025

    📎  IF you have Original Medicare like I do, what do you LIKE/DISLIKE about it? Me, so far only "like" for me. At age 67, I have ALWAYS had it along with a STANDALONE Part D for my High Blood Pressure & Chlolestral meds. Working on getting OFF them both. My 1st Part D was with AETNA before they decided to "delete" my cheap plan in 2025. Moved to WELLCARE and so far ZERO cost for me (no premium cost or prescriptions). Lol, hoping this "continues" when we have OPEN ENROLLMENT next month (October).

     

    ➡️[*** Any Advantage members? What do you like or dislike about it?

     

    Take care,

    Nicole (Medicare Forum)

    C
    CBtoo
    Conversationalist ⭐⭐
    September 16, 2025

    I am NOT on an advantage plan by choice. I have cancer. I could not go to MD Anderson Cancer Center (#1 cancer center in the nation) if I was on an advantage plan as they accept only one local to Houston and I live out of state. The Mayo clinic (also tops for many things) has a number of restrictions and don't accept much in the way of advantage plans either. 

    Networks matter to me. And on advantage plans networks can change mid year. Then you have to change your advantage plan if you lost a doctor you value. 

     

    If you are sick with something expensive your costs will be much higher on an advantage plan than if you have most supplements. On an advantage plan you may or may not be able to be seen by the "best" specialist in your area (or out of state). Referrals will be required and about 1/3 are denied which will delay care. You may be required to do something other than what your doctor recommended due to "step" plans (you have to show something else failed before you can do what your doctor thinks is best. These are all risks I am NOT willing to take so I pay for supp G as then my only cost is premiums and my B deductible. That is way cheaper than any of the advantage plan maximum out of pockets (I have a number of health problems). And I can go to the best specialists in the country for my issues. 

    If you are healthy now an advantage plan will certainly be cheaper. BUT if you get sick that may well change and depending on the state you are in you may be trapped for life in an advantage plan if (not all diseases will cause you to fail) now you fail medical underwriting and can't switch. 

    If you live in a big city where the good medical systems accept all, or nearly all, of the advantage plans then likely you could be OK with respect specialists if you need one (you may well find though you are paying way more if you get sick with something expensive due to the high advantage plan out of pockets). 

    If you live in a rural area or an area without any good medical systems then the need to travel becomes higher if you need specialist care, or at least a second opinion. That is where advantage plans (except some PPO's and those are disappearing into HMO's in 2026) can be very limiting. You may not be able to do that. And your referral may not be approved. Original medicare doesn't require a referral (and the 6 states where they were going to introduce the need for referrals for 15 conditions with original medicare has been put on hold due to a lawsuit that this violates medicare laws).

    D's aren't different because the law requires the same out of pocket limit. What is different between all of them (part of an advantage plan or not) is the formularies, which tier drugs are in and what they charge in the higher tiers (beware of a % of the drug cost vs a flat fee). Also after 3 months they are allowed to change what is in the formulary.

     

    If you are on an advantage plan you might be able to solve a new D "problem" or new network "problem" by changing plans. On a supplement you can use any doctor or system that accepts medicare nationwide. With D's you are trapped in that D until Jan1 of the next year. 

    If you can't afford supplement premiums nor advantage plan out of pockets (and don't qualify for medicaid too) then you can't afford medical care. Then your only choice is to find out if there is any financial aid available (often not if you have insurance of any kind) or see if you have any systems that don't cut off care and sue you if you end up in collection. If there is a system like that then that is the only system you can use (outside of the ER) so that you won't have care cut off when you end up in collection. In collection you likely will get nagged by the collection agency but that is better than having no care at all and being sued. 

      SummerOnTheWay1
      SummerOnTheWay1Author
      September 16, 2025

      📎  Carolyn @CBtoo , I am so sorry to hear about your cancer. Sending healing your way my friend. Nicole  💛💛💛

       

      ➡️[*** CSROLYN 

      @CBtoo wrote:

      I am NOT on an advantage plan by choice. I have cancer. I could not go to MD Anderson Cancer Center (#1 cancer center in the nation) if I was on an advantage plan as they accept only one local to Houston and I live out of state. The Mayo clinic (also tops for many things) has a number of restrictions and don't accept much in the way of advantage plans either. 

      Networks matter to me. And on advantage plans networks can change mid year. Then you have to change your advantage plan if you lost a doctor you value. 

       

      If you are sick with something expensive your costs will be much higher on an advantage plan than if you have most supplements. On an advantage plan you may or may not be able to be seen by the "best" specialist in your area (or out of state). Referrals will be required and about 1/3 are denied which will delay care. You may be required to do something other than what your doctor recommended due to "step" plans (you have to show something else failed before you can do what your doctor thinks is best. These are all risks I am NOT willing to take so I pay for supp G as then my only cost is premiums and my B deductible. That is way cheaper than any of the advantage plan maximum out of pockets (I have a number of health problems). And I can go to the best specialists in the country for my issues. 

      If you are healthy now an advantage plan will certainly be cheaper. BUT if you get sick that may well change and depending on the state you are in you may be trapped for life in an advantage plan if (not all diseases will cause you to fail) now you fail medical underwriting and can't switch. 

      If you live in a big city where the good medical systems accept all, or nearly all, of the advantage plans then likely you could be OK with respect specialists if you need one (you may well find though you are paying way more if you get sick with something expensive due to the high advantage plan out of pockets). 

      If you live in a rural area or an area without any good medical systems then the need to travel becomes higher if you need specialist care, or at least a second opinion. That is where advantage plans (except some PPO's and those are disappearing into HMO's in 2026) can be very limiting. You may not be able to do that. And your referral may not be approved. Original medicare doesn't require a referral (and the 6 states where they were going to introduce the need for referrals for 15 conditions with original medicare has been put on hold due to a lawsuit that this violates medicare laws).

      D's aren't different because the law requires the same out of pocket limit. What is different between all of them (part of an advantage plan or not) is the formularies, which tier drugs are in and what they charge in the higher tiers (beware of a % of the drug cost vs a flat fee). Also after 3 months they are allowed to change what is in the formulary.

       

      If you are on an advantage plan you might be able to solve a new D "problem" or new network "problem" by changing plans. On a supplement you can use any doctor or system that accepts medicare nationwide. With D's you are trapped in that D until Jan1 of the next year. 

      If you can't afford supplement premiums nor advantage plan out of pockets (and don't qualify for medicaid too) then you can't afford medical care. Then your only choice is to find out if there is any financial aid available (often not if you have insurance of any kind) or see if you have any systems that don't cut off care and sue you if you end up in collection. If there is a system like that then that is the only system you can use (outside of the ER) so that you won't have care cut off when you end up in collection. In collection you likely will get nagged by the collection agency but that is better than having no care at all and being sued. 

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