Almost everyone ends up on one of two paths. Neither is "best" for everyone; it comes down to your doctors, your prescriptions, how much you travel and how you'd rather pay.
| Original Medicare + Medigap + Part D | Medicare Advantage (Part C) | |
|---|---|---|
| Who runs it | The federal government (Parts A and B), plus private Medigap and Part D plans you add | A private insurer approved by Medicare, all in one plan |
| Doctors and hospitals | Any provider in the U.S. that takes Medicare. No referrals needed. | Usually a network (HMO or PPO). Check that your doctors and hospital are in it, every year. |
| Monthly cost | Part B premium, plus Medigap and Part D premiums. Higher and steadier. | Part B premium, plus the plan's premium, which is often low or $0. |
| When you use care | Medigap covers most or all of the 20% Part B leaves you, depending on the plan letter. | Copays and coinsurance as you go, up to a yearly out-of-pocket maximum. |
| Prescriptions | A separate Part D plan | Usually built in |
| Extras (dental, vision, hearing) | Not included; buy separately if you want them | Often included, with limits |
| Prior approval for care | Rarely needed | More common for some tests, procedures and stays |
| Travel and winters away | Works anywhere in the U.S. | Outside the network, often emergencies only |
| Changing your mind | Easy to change Part D each fall | You can go back to Original Medicare in the fall or Jan 1 – Mar 31, but a Medigap insurer may then ask health questions and can say no |
Your first Medigap window (six months starting with Part B at 65 or older) is the one time insurers must sell you any Medigap policy at their standard price, whatever your health. If you start on Medicare Advantage and want to switch to Original Medicare plus Medigap years later, you may have to pass health questions. That's not a reason to avoid Advantage plans; it's a reason to decide on purpose.
you want any doctor in the country, spend winters away, see specialists often, or prefer predictable costs over low premiums.
your doctors are in a local network, you're comfortable with referrals and approvals, and you'd rather keep premiums low and get extras like dental or vision.
Compare actual plans and prices at medicare.gov/plan-compare, or get free one-on-one help from PA MEDI.