Caring for an aging loved one can mean facing big choices about health coverage. Original Medicare and Medicare Advantage both help pay for medical care. But they differ in how they work, what they cover, and what they cost. Medigap, also known as a Medicare Supplement plan, can pair with Original Medicare to fill gaps. This guide compares the different coverage clearly so we can help the person we care for pick the best fit for their health and financial situations.

What Original Medicare covers

Original Medicare has two main parts:

Part A (Hospital Insurance)

Part A covers inpatient hospital stays, care in a skilled nursing facility (short-term after a hospitalization), hospice, and some home health care.

Part B (Medical Insurance)

Part B covers doctor visits, outpatient care, preventive services, lab tests, x-rays, mental health care, and durable medical equipment like walkers, wheelchairs, hospital beds, and some home health care.

Part B does not cover routine dental, routine vision or hearing care. But it does cover non-routine dental and vision care. For example, it could cover a vision exam and glasses if our loved one needs cataract surgery, or dental reconstruction after cancer that affected their jaw.

Part D (Prescription Drug Plans)

Medicare Parts A and B don’t cover most prescription drugs (only infused drugs like chemotherapy). So Medicare Part D plans are offered to Original Medicare enrollees by private companies, to cover many other prescription medications. There are usually several Part D plans to choose from in each state. To avoid paying a penalty, our loved one would have to enroll in a Part D plan when they first become eligible for Medicare if they choose coverage through Original Medicare. 

How much are Original Medicare premiums?

Most people get Part A free if they or a spouse paid Medicare taxes for at least 10 years. Part B costs a standard monthly premium of $202.90 in 2026. This premium is the same no matter which state we live in. People with incomes higher than $109,000 ($218,000 for those who file taxes jointly) will pay a slightly higher premium. 

How much are Original Medicare deductibles?

Part A doesn’t have an annual deductible. It has a deductible for each benefit period. A benefit begins the day our loved one is admitted as an inpatient to a hospital or a Medicare‑covered skilled nursing facility (SNF).​ It ends when they’ve been out of the hospital and not receiving skilled care in a SNF for 60 days in a row. In 2026, the Part A deductible is $1,736 per benefit period.

If the person we care for is hospitalized or receiving care at a SNF, once they pay for $1,736 worth of care during a given benefit period, these are the co-insurance amounts they may be responsible for:

Hospital Stay:

• Days 1-60: $0 
• Days 61-90: $434/day
• Days 91-150: $868/day while using 60 lifetime reserve days‍
• After day 150: All costs until a new benefit period starts

SNF:

• Days 1-20: $0
• Days 21-100: $217/day
• Days 101: All costs until a new benefit period starts

Yikes! That can add up to a lot of money. Especially if the person we care for has more than one benefit period in a year. The good news is that a Medigap plan can cover these deductibles and co-insurance payments. I’ll explain Medigap plans in a bit. Just wanted to take a second now to ease the sticker shock up here. 

Part B has a single annual deductible; once the person we care for meets it, Medicare will generally pay 80% of the Medicare‑approved amount for most covered services, and our loved one will pay 20% coinsurance.​ Some Part B services (for example, certain preventive services) may be covered at 100% with no deductible or coinsurance.

Part D has deductibles that vary by Part D plan. But they cannot be higher than the maximum set by the Center for Medicare and Medicaid Services (CMS). In 2026, this maximum is $615. Many plans have much lower or even $0 deductibles.

The role of Medigap (Medicare supplement)

Remember those high hospital and SNF costs listed above? Well, a Medigap plan can cover Original Medicare deductibles, coinsurance, and copays that the person we care for may incur. There are 10 Medigap plans (A through N), each offering different coverage. All Medigap plans cover some or all of the Part A deductible. Popular Medigap plans, like Plan G, cover nearly all gaps except the Part B deductible ($283 in 2026). Plans C and F do cover the Part B deductible. But only enrollees who were Medicare-eligible before January 1, 2020 can keep or purchase these two plans, if the plans are available in their state. And Plans K and L also have annual out-of-pocket maximums. 

Premiums for Medigap vary widely by state, beneficiary age, and plan—the national average is around $217/month. Medigap plans allow nationwide access to providers that accept Medicare. Our loved one can only purchase a Medigap policy if they have Original Medicare, not Medicare Advantage. 

What Medicare Advantage covers

Medicare Advantage (MA) plans (a.k.a. Part C) are offered and managed by private insurance companies that have a contract with the Federal Government to administer Medicare benefits. They must offer at least the same benefits and costs as Original Medicare. But most Medicare Advantage plans offer additional benefits not covered by Original Medicare, as well as lower cost-sharing.

Most MA plans also offer:

• Prescription drug coverage 
• Routine and non-routine dental, routine and non-routine vision, and hearing benefits

Many also offer supplemental benefits aimed at preventing illness:

• Fitness programs
• Meal delivery
• Transportation to doctor appointments
• Acupuncture
• Prepaid debit card to pay for over the counter items and services

The cost of MA plans varies, but at minimum, our loved one would have to pay the Part B premium ($202.90/month standard). From there, the plan may or may not add a premium. The national average has hovered around $17 in recent years.​ That said, for people who meet certain low income and asset criteria, the Part B premium can be covered by the Medicare Savings Program (MSP).

How Original Medicare and Medicare Advantage differ: provider choice and home health services

Original Medicare (with or without Medigap) lets you see any healthcare provider nationwide that accepts Medicare, which includes about 90% of all healthcare providers. In most cases, no referrals are needed for specialists. 

MA plans operate as HMOs or PPOs. The HMO plans generally require members to see healthcare providers in the plan’s network. Out-of-network care costs extra or is not covered (except in emergencies). And these plans usually require prior authorizations and PCP referrals before seeing a specialist. 

Another important difference between Original Medicare and MA plans is how they manage the Medicare home health benefit for homebound members who need skilled medical care at home. The Medicare home health benefit covers skilled nursing, physical, occupational, and speech therapy, as well as home health aide services for eligible homebound beneficiaries.

Original Medicare charges no copays for visits, and covers home health services for as long as they’re medically necessary. 

All MA plans have to cover home health services using the same criteria as Original Medicare. But sometimes they may cover a smaller amount and duration of home health services than Original Medicare would. When they don't cover the care, or only cover a few visits, it may be because the MA plan is making a “utilization management” decision—they’re deciding that the care is not medically necessary. Unfortunately, this decision can force home health agencies to discharge some patients prematurely. And that can result in poor health outcomes, avoidable re-hospitalizations, and unprepared, burned‑out family caregivers.

Many MA plans also require prior authorizations and have narrow networks. And home health agencies find some MA plans difficult to work with, so they may only accept patients on a handful of plans. All of this can limit access to this benefit. 

RubyWell offers families a free service that predicts eligibility for the Medicare home health benefit. And their support team guides families step-by-step through the process of accessing the covered care our loved one may be entitled to. Right now, RubyWell can work with patients covered by Original Medicare in Arizona and some parts of Florida and Pennsylvania, as well as patients on a handful of Medicare Advantage plans in Arizona. To check eligibility, take the quiz.

Medicare costs, side-by-side

This table is useful as we compare the kinds of Medicare coverage available.

Pros and cons for each Medicare coverage

Original Medicare Pros & Cons

Pros: Wide choice of doctors, no networks, no prior authorization, accepted nationwide.
Cons: No routine vision, routine dental or hearing coverage, need to pay for Part D plan, no cost cap.

Original Medicare + Medigap Pros vs Cons

Pros: Wide choice of doctors, no networks, nationwide access, no prior authorization, covers most out-of-pocket costs.
Cons: Need to pay for Medigap and Part D plans. Some—but not all—Medigap plans offer optional routine dental, vision and/or hearing benefits as an "add on" to the standard Medigap policy.

Medicare Advantage Pros vs Cons

Pros: May cover routine dental, vision and hearing, lower copays or cost sharing, cost cap, low or no additional premium beyond the Medicare Part B premium.
Cons: Networks may limit choice, require prior approvals, may provide local or regional coverage only, may limit home health visits.

How to choose Medicare coverage

Every state has a State Health Insurance Assistance Program (SHIP) that offers free, unbiased guidance on choosing Medicare coverage. Since they don’t sell insurance plans, there’s no hard sell to worry about. Medicare also has a helpful tool at Medicare.gov/plan-compare. We can consult this during both Enrollment Periods: 

• The Medicare Advantage Annual Enrollment Period (AEP) runs from Oct 15-Dec 7 every year. During this period, anyone who’s eligible for Medicare may select new coverage or choose to keep the coverage they have for the following calendar year. 
• Medicare Advantage Open Enrollment Period (OEP) runs from Jan 1-Mar 31 every year. During this period, anyone who’s already on a Medicare Advantage plan may select a new MA plan, switch to Original Medicare, or choose to keep the coverage they have. Any changes go into effect the first day of the month following the requested plan change.  

There are also Special Election Periods (SEPs) when the person we care for may change their Medicare coverage. 

• If our loved one moves out of their MA plan’s service area, they can make a switch to another MA plan that serves their new area.
• If they’re newly diagnosed with a severe chronic condition, like cancer or congestive heart failure, they can switch to a Special Needs Plan (SNP) that’s tailored to that chronic condition and may provide extra coverage, like more days in the hospital.
  

Things to keep in mind when choosing Medicare coverage

As we help the person we care for consider which coverage is best for them, here are five questions to ask them (and ourselves).‍

1. How important is it to be able to see any doctor or go to any care facility they want, without needing prior authorization?

If this is a top priority, Original Medicare may be the way to go.

2. How important are predictable medical expenses? 

Original Medicare plus Part D and a Medigap plan with an out of pocket maximum will provide the clearest picture of your annual costs. 

3. How much can the person I care for afford to pay in premiums every month?

Medicare Advantage will likely have lower premiums than the total cost of Original Medicare with separate Part D and Medigap plans.

4. Since routine dental, vision, and hearing aren’t included in Original Medicare coverage, can my loved one afford to pay for those visits out of pocket or can they afford a Medigap plan that covers them?

If not, Medicare Advantage may be the best option.

5. Am I concerned about the person I care for having access to the medically necessary home health services they may need now or in the future?

Medicare Advantage plans may limit the home health agencies you can work with to only those that are in their network. And many MA plans may limit access to home health by requiring prior authorizations.

It’s a lot to think about. But taking the time to weigh all the options and consider all the implications will likely lead to finding the right coverage for our loved one’s unique situation. The main goal is to keep care costs low and have access to the care they need to live safely at home and stay out of the hospital.