Medicare Advantage vs Original Medicare: How Each Handles Doctor Visits, Telehealth and Prescriptions

The short answer

Original Medicare gives you the widest choice of doctors with few approval steps. Medicare Advantage usually limits you to a network. In return, you get a yearly cost limit and, in most plans, drug coverage in one place. Neither is right for everyone.

The federal government runs Original Medicare: Part A (hospital insurance) and Part B (medical insurance). Private companies that Medicare approves offer Medicare Advantage plans, sometimes called Part C. These plans must cover all emergency and urgent care, and almost all medically necessary services Original Medicare covers.

For the bigger picture, see what's changing in Medicare Advantage for 2027.

Choosing doctors

With Original Medicare, you can use any doctor or hospital that takes Medicare, anywhere in the U.S. That helps if you see specialists in different places or spend part of the year away from home. Outside the U.S., neither usually covers care. Some Medicare Advantage plans offer an extra benefit for emergency care while traveling.

With Medicare Advantage, you may need to use the plan's network: the doctors and hospitals it works with. You may also need to get care in the plan's service area. Emergency and urgent care are covered either way. Some plans cover care outside the network, usually at a higher cost. Networks can change each year, so check your plan's directory or call your doctors' offices.

Referrals and prior authorization

A referral is a written OK from your primary care doctor to see a specialist. Prior authorization means the plan must approve a service, supply or drug before it pays.

• Original Medicare: you usually don't need a referral, and only a limited set of services needs prior authorization.

• Medicare Advantage: you may need a referral for a specialist, and approval first for certain services or supplies. In 2026, 99% of Medicare Advantage members are in plans that use prior authorization for some services, KFF found. It's most common for hospital and skilled nursing facility stays, and rare for preventive care.

If a Medicare Advantage plan denies a request, you can appeal. The denial notice explains how and by when.

Telehealth in each

Medicare's expanded telehealth rules run through December 31, 2027. You can have covered telehealth visits from anywhere in the U.S., including your home. Some visits can be by phone (audio only).

• Original Medicare: for most services, you pay the same as you would in person (see Costs at a glance).

• Medicare Advantage: plans cover the same telehealth and may add more. What you pay depends on the plan, so check its Evidence of Coverage (the document that lists what the plan covers and what you pay).

Our guide to what telehealth services Medicare covers has the details.

Is a renewal worth a morning off while you're still comparing coverage? A video visit can handle a renewal (a new prescription for a medicine you already take) or a new health question. Doctronic accepts Medicare, and you can see a licensed doctor by video.

Prescriptions

Drug coverage works differently in each, though both follow Part D's rules.

• Original Medicare: for drug coverage, you can join a separate Medicare drug plan (Part D).

• Medicare Advantage: most plans include Part D drug coverage, so you don't need a separate drug plan.

Either way, Part D changes on January 1, 2027. The yearly cap on covered drug costs rises to $2,400, from $2,100 in 2026. The highest deductible a plan can charge rises to $700, from $615. Each plan has its own drug list, tiers and approval rules, so check every drug you take.

Our guide to Medicare Part D in 2027 explains drug lists, tiers and deductibles.

Costs at a glance

The two are built differently, so compare the structure before the numbers.

• Both: you pay the Part B premium.

• Original Medicare: you also pay deductibles. After the Part B deductible, you usually pay 20% of the Medicare-approved amount. There's no yearly limit on what you pay unless you have supplemental coverage, such as Medigap (supplemental insurance sold by private companies for Original Medicare).

• Medicare Advantage: you may also pay a plan premium, plus the plan's copays or coinsurance. Plans have a yearly limit on what you pay for covered Medicare services. You can't use Medigap with a Medicare Advantage plan.

Extra benefits differ too. Routine eye exams and most dental care aren't covered by Original Medicare. A Medicare Advantage plan may offer some vision, hearing and dental services.

Questions to ask before you choose

Use your own doctors, drugs and habits to compare:

1. Are my doctors and hospitals in the plan's network?

2. Is each drug I take on the plan's drug list, and does it need prior authorization or step therapy (trying a lower-cost drug first)?

3. Will I need referrals to see my specialists?

4. What telehealth does the plan cover, and what do I pay for it?

5. Do I travel or live part of the year in another state?

6. What's the most I could pay in a year for medical care and drugs?

Doctronic isn't an insurance agent or broker and doesn't recommend plans. For free, unbiased help:

• Medicare.gov: the Medicare Plan Finder compares plans' costs, drug lists, doctors and star ratings.

• 1-800-MEDICARE (1-800-633-4227): Medicare's own help line.

• Your State Health Insurance Assistance Program (SHIP): free, one-on-one counseling.

For the basics of each part of Medicare, see our beginner's guide to Medicare.

Frequently Asked Questions

Is Medicare Advantage the same as Original Medicare?

No. Medicare Advantage is another way to get your Part A and Part B benefits. Once you join, the plan pays for your covered care instead of Original Medicare.

Can I see any doctor with Medicare Advantage?

Not always. For care that isn't an emergency or urgent, many plans ask you to use network doctors, or charge more outside the network.

Can I have Medigap with Medicare Advantage?

No. Medigap only works with Original Medicare. Medigap insurers may be able to turn you down or charge more if you apply after your Medigap Open Enrollment Period.

When can I change between Original Medicare and Medicare Advantage?

During open enrollment, October 15 to December 7, with changes starting January 1 of the next year. Medicare Advantage members can also change plans or return to Original Medicare between January 1 and March 31. Details for 2027 coverage are in our guide to Medicare open enrollment 2027.

How do I know if my Medicare Advantage plan is changing next year?

Read your plan's Annual Notice of Change. Plans send it each fall, and it lists changes to costs, coverage, networks and service area that start in January.

The Bottom Line

List your doctors, your drugs and how often you travel. Then check each one against Original Medicare with a Part D plan and the Medicare Advantage plans in your area. The free help listed above can guide you.