Open enrollment for Medicare is just around the corner, and it’s the perfect time to think about your healthcare options. Medicare primarily serves people 65 and older, though some younger individuals with specific disabilities or conditions may also qualify.
When it comes to coverage, you have two main paths: Original Medicare or a Medicare Advantage plan. Open enrollment for traditional Medicare runs from Oct. 15 through Dec. 7, while those with Medicare Advantage can make changes between Jan. 1 and March 31.
Understanding Original Medicare
Original Medicare, also called traditional Medicare, provides coverage for inpatient hospital care, skilled nursing facilities, hospice, and home health services, according to the Centers for Medicare and Medicaid Services. It also covers doctor visits, outpatient care, “durable medical equipment” like wheelchairs and walkers, and preventive services such as screenings, an annual wellness visit, and certain vaccines.
Medicare has four parts: Part A covers hospital insurance, Part B is medical insurance, Part C refers to Medicare Advantage plans, and Part D is prescription drug coverage.
People with Medicare can go to any doctor or hospital, anywhere in the United States that accepts Medicare. If they have traditional Medicare, they can also buy Medicare Supplement Insurance (Medigap) policy from a private insurance company,” the federal agency previously told the Miami Herald in an email.
“Traditional Medicare pays for much, but not all, of the cost for covered healthcare services and supplies. A Medigap policy can help pay some of the remaining healthcare costs, such as co-payments, coinsurance and deductibles.”
The agency also recommends that anyone with traditional Medicare enroll in Part D to cover prescription drugs. This ensures you have hospital, medical, and prescription coverage.
| Feature | Original Medicare | Medicare Advantage |
| Doctors and Hospitals | Any doctor/hospital that accepts Medicare, usually no referrals | Must use network providers, may need referrals |
| Coverage | Covers most medically necessary services; extra benefits like vision and dental require additional policies | Covers all medically necessary services and may offer extra benefits, often bundled with prescription drug coverage |
| Pre-Authorization | Typically not needed (with some changes coming in 2026 in certain states) | Often required for certain services |
| Costs | You usually pay 20% of the Medicare-approved amount for Part B services after deductible; no yearly out-of-pocket limit unless using Medigap | Out-of-pocket limits exist for services; once reached, you pay nothing more for the year |
Original Medicare offers flexibility, while Medicare Advantage can provide extra benefits and an out-of-pocket cap, but you may be limited to a network of providers. Choosing the right plan depends on your healthcare needs, budget, and preferred doctors.
What You Should Know About Medicare Advantage
A Medicare Advantage plan usually bundles original Medicare hospital and medical insurance with Medicare prescription drug coverage into a single health plan.
“If someone selects Medicare Advantage coverage, they join a plan offered by Medicare-approved private companies. Each plan can have different rules for how someone gets services like referrals to see a specialist,”
All plans must cover emergency and urgent care, as well as all medically necessary services covered by traditional Medicare. However, while most Medicare Advantage plans include hospital, medical and prescription drug coverage, you can’t go to any doctor you want. Medicare Advantage plans usually require you to use doctors and other providers who are in a plan’s network and service area.
Unlike traditional Medicare, Medicare Advantage often requires pre-authorization for certain services, while Original Medicare generally does not, although that may change in some states in 2026. A new program will require pre-authorization for items like skin and tissue substitutes, epidural steroid injections for pain and deep brain stimulation for Parkinson’s disease, aiming to reduce unnecessary procedures.
Doctors, Networks, and Coverage Choices
If you want to keep your current doctors, Original Medicare is flexible: you can visit any provider that accepts Medicare without needing referrals.
For Medicare Advantage, you must use network providers, and some plans may require a referral to see a specialist.
The federal agency said
“Costs for monthly premiums and services vary depending on which plan you join, and some plans may offer some extra benefits that traditional Medicare doesn’t cover like vision, hearing and dental services,”
You can check if your doctors accept Medicare or Medicare Advantage via the Medicare provider database online.
Prescription Coverage and Part D
With Medicare Part D, you can pay your prescription costs throughout the year with monthly capped payments instead of paying everything upfront at the pharmacy. The goal isn’t to make medications cheaper, but to help manage monthly expenses.
Starting in 2026, automatic re-enrollment for the prescription payment plan will occur unless you opt out. For traditional Medicare users, enrolling in Part D is strongly recommended, while most Medicare Advantage plans include drug coverage already.
Premiums for Part D plans are expected to rise slightly in 2026, with the out-of-pocket cap increasing from $2,000 to $2,100.
