Medicare Advantage vs. Original Medicare: What Phoenix Residents Should Know for 2027

If you're reviewing Medicare coverage for 2027, one of the biggest questions you may encounter is whether you want to receive your Medicare benefits through Original Medicare or Medicare Advantage.

Both are ways to receive Medicare coverage, but they work differently.

Those differences can affect which doctors you see, how you receive prescription drug coverage, your potential out-of-pocket costs, whether you can use Medicare Supplement Insurance, and how your coverage works when you're away from home.

With Medicare Open Enrollment running from October 15 through December 7, now is a good time for Phoenix Medicare beneficiaries to understand the differences before making decisions about 2027 coverage.

Daisy Nadolski is a licensed insurance agent serving Phoenix and clients throughout Arizona who helps Medicare-eligible adults understand and compare available Medicare options.

Here's what you should know.

What Is Original Medicare?

Original Medicare is the traditional federal Medicare program.

It includes:

Medicare Part A: Hospital Insurance

Medicare Part B: Medical Insurance

With Original Medicare, you can generally use any doctor or hospital in the United States that accepts Medicare.

Original Medicare does not automatically include prescription drug coverage. If you want Medicare drug coverage, you can generally enroll in a separate Medicare Part D plan.

You may also be able to purchase Medicare Supplement Insurance, commonly called Medigap, to help pay some of the out-of-pocket costs that Original Medicare doesn't cover.

What Is Medicare Advantage?

Medicare Advantage, also called Medicare Part C, is another way to receive your Medicare Part A and Part B benefits.

Medicare Advantage plans are offered by private insurance companies approved by Medicare.

Most Medicare Advantage plans include Medicare Part D prescription drug coverage, and many plans offer additional benefits that Original Medicare doesn't cover.

However, Medicare Advantage plans may have provider networks, service areas, referral requirements, prior authorization requirements, and other plan rules.

You must have both Medicare Part A and Part B to join a Medicare Advantage plan.

Medicare Advantage vs. Original Medicare: Doctor Choice

Provider access is one of the major differences to consider.

Original Medicare

With Original Medicare, you can generally see any doctor or use any hospital in the United States that accepts Medicare.

This can provide flexibility for people who travel frequently or see providers in different areas.

Medicare Advantage

With Medicare Advantage, you may need to use doctors and other healthcare providers within the plan's network and service area for non-emergency care.

Some plans offer out-of-network coverage, sometimes at a higher cost.

Depending on the plan, you may also need referrals to see certain specialists.

For Phoenix residents who already have doctors they want to keep, provider networks should be one of the first things you review when comparing Medicare Advantage plans.

How Do Costs Compare?

Costs work differently under Original Medicare and Medicare Advantage. Speak with Daisy to learn more

Original Medicare Costs

With Original Medicare, you generally pay your Part B premium and your share of the cost when you receive covered healthcare.

For many Part B-covered services, you typically pay 20% of the Medicare-approved amount after meeting the applicable deductible.

Original Medicare itself does not have an annual out-of-pocket maximum.

Some beneficiaries purchase Medicare Supplement Insurance to help cover certain out-of-pocket costs associated with Original Medicare.

If you choose a separate Part D prescription drug plan, that coverage may have its own premium and costs.

Medicare Advantage Costs

With Medicare Advantage, you continue paying your Medicare Part B premium and may also have a premium for the Medicare Advantage plan.

Plan costs vary.

Medicare Advantage plans have annual limits on what you pay out of pocket for covered Medicare services. Depending on the plan, there may be different limits for in-network and out-of-network services.

When comparing plans, don't look at the premium alone.

Consider deductibles, copays, coinsurance, prescription costs, provider networks, and the annual out-of-pocket limit.

What About Prescription Drug Coverage?

Prescription coverage is another important difference.

With Original Medicare, you can generally choose to enroll in a separate Medicare Part D prescription drug plan.

Most Medicare Advantage plans include Medicare prescription drug coverage as part of the plan.

Whichever route you're considering, review your actual prescriptions.

Check:

• Whether your medications are covered

• Your expected costs

• Formulary placement

• Pharmacy participation

• Coverage requirements or restrictions

A plan that works well for someone else's prescriptions may not be a good match for yours.

Can You Have Medigap With Medicare Advantage?

No.

Medicare Supplement Insurance, or Medigap, is designed to work with Original Medicare.

You cannot use Medigap to pay Medicare Advantage plan copayments, deductibles, or premiums.

If you're considering switching from Medicare Advantage back to Original Medicare and want Medigap coverage, don't assume you'll automatically be able to purchase any Medigap policy you want.

Your ability to purchase a policy and the rules that apply can depend on your circumstances and enrollment rights.

This is an important issue to understand before making a coverage change.

What About Dental, Vision, and Hearing Benefits?

Original Medicare generally does not cover routine dental care, routine eye exams, or hearing aids.

Medicare Advantage plans may offer additional benefits that Original Medicare doesn't cover, which can include certain dental, vision, and hearing benefits.

Benefits vary by plan.

Rather than choosing a Medicare Advantage plan simply because it advertises additional benefits, consider the complete coverage package.

Your doctors, prescriptions, healthcare needs, costs, and coverage rules should all be part of the decision.

Which Option Is Better for Someone Who Travels?

This depends on how and where you travel.

Original Medicare generally allows you to receive covered care from any doctor or hospital in the United States that accepts Medicare.

Medicare Advantage plans generally use a service area and may require you to use network providers for non-emergency care. Some plans provide additional out-of-network coverage.

If you spend significant time outside Arizona, travel frequently, or split your time between locations, this is an important consideration when comparing options.

Is Medicare Advantage Better Than Original Medicare?

There isn't a universal answer.

One person may prioritize broad provider access.

Another may prefer having medical and prescription coverage combined within one Medicare Advantage plan.

Someone else may value the ability to pair Original Medicare with a Medigap policy.

The better question is:

How does each available option fit your healthcare needs, doctors, prescriptions, budget, lifestyle, and preferences?

That's the comparison that matters.

Questions Phoenix Residents Should Ask Before Choosing

Before making a Medicare coverage decision for 2027, ask:

• Are my doctors and specialists available under this coverage?

• How are my prescriptions covered?

• What are my potential annual healthcare costs?

• Will I need referrals?

• Are prior authorizations required for services I use?

• How does the coverage work when I travel?

• Do I want separate prescription drug coverage or combined coverage?

• Is Medigap important to me?

• Have my healthcare needs changed since last year?

Write down your priorities before comparing options. It can make it much easier to recognize which differences actually matter to you.

Medicare Open Enrollment in Phoenix for 2027

Medicare Open Enrollment runs October 15 through December 7, 2026.

During this period, eligible Medicare beneficiaries can make certain changes to their Medicare health and prescription drug coverage for 2027.

Changes made during Medicare Open Enrollment generally take effect January 1, 2027.

If you're considering switching between Original Medicare and Medicare Advantage, changing Medicare Advantage plans, or reviewing prescription drug coverage, don't wait until the final day to start researching your options.

Get Medicare Help in Phoenix

Comparing Original Medicare and Medicare Advantage involves much more than looking at an advertisement or monthly premium.

Provider networks, prescriptions, healthcare costs, travel, Medigap, plan rules, and your personal healthcare needs can all affect your decision.

Daisy Nadolski is a licensed insurance agent serving Phoenix and clients throughout Arizona. She helps Medicare-eligible adults understand their Medicare insurance options and compare available coverage based on their individual circumstances.

Daisy's assistance comes at no cost to you.

Frequently Asked Questions About Original Medicare and Medicare Advantage

Is Medicare Advantage the same as Medicare?

Medicare Advantage is an alternative way to receive your Medicare Part A and Part B benefits through a Medicare-approved private insurance company. You must have Part A and Part B to join a Medicare Advantage plan.

Can I have Medicare Advantage and Medigap at the same time?

No. Medigap is supplemental coverage designed to work with Original Medicare and cannot be used to cover Medicare Advantage plan costs.

Does Original Medicare include prescription coverage?

Original Medicare does not automatically include Part D prescription drug coverage. Beneficiaries can generally choose to enroll in a separate Medicare drug plan.

Do Medicare Advantage plans include prescription coverage?

Most Medicare Advantage plans include Medicare Part D prescription drug coverage.

Can I keep my doctor with Medicare Advantage?

It depends on the plan and provider. Medicare Advantage plans may use provider networks, so check whether your doctors and specialists participate in the specific plan you're considering.

When can I switch between Original Medicare and Medicare Advantage?

Medicare's Annual Open Enrollment Period runs October 15 through December 7. Depending on your current coverage and circumstances, other enrollment periods may also apply.

Can a Medicare insurance agent in Phoenix help me compare my options?

Yes. A licensed insurance insurance agent can help explain differences among available Medicare coverage options. Daisy Nadolski helps Medicare-eligible clients in Phoenix and throughout Arizona understand and compare their options at no cost to them.

Understand Your Medicare Choices for 2027

Original Medicare and Medicare Advantage can both provide Medicare coverage, but they work differently.

Before making a decision for 2027, consider your doctors, prescriptions, healthcare needs, expected costs, travel habits, and the way you prefer to receive your healthcare.

If you'd like personalized assistance comparing available Medicare options, Daisy Nadolski serves Medicare beneficiaries in Phoenix and throughout Arizona.