Key Takeaways
- Original Medicare usually means Part A (hospital) and Part B (medical) through the federal Medicare program. You can add Part D for drugs and, in many cases, buy a Medigap policy to help with out-of-pocket costs.
- Medicare Advantage (Part C) is a different way to get Parts A and B: a Medicare-approved private plan that must follow Medicare rules and must cover everything Original Medicare covers, with different cost and network rules. Most plans include Part D. See Medicare.gov — your health plan options.
- You generally choose a path: Original Medicare (often plus Part D and maybe Medigap) or Medicare Advantage—not both Medigap and Medicare Advantage at the same time. Medicare.gov explains how Medigap and Medicare Advantage interact.
- In Brooklyn and NYC, your ZIP code and county decide which plans are offered. Always confirm doctors, drugs, and costs in the plan’s official materials and tools like Medicare Plan Compare—benefits change each year.
- What Is Original Medicare?
- What Is Medicare Advantage (Part C)?
- Medicare Advantage vs Original Medicare at a Glance
- Premiums, Deductibles, and Your Share of Costs
- Doctors, Networks, and Care in NYC (and Beyond)
- Prescription Drugs: Part D and Formularies
- Medigap vs Medicare Advantage: Why You Usually Pick One Path
- Practical Steps Before You Enroll or Switch
- Free Help for New York City Beneficiaries
- Frequently Asked Questions
- Take the Next Step
Original Medicare is the traditional program run by the federal government. For most people, it means Part A covers inpatient hospital care, skilled nursing under certain rules, hospice, and some home health. Part B covers doctor visits, outpatient care, preventive services, durable medical equipment, and many other medical services not covered by Part A.
You can see any provider that accepts Medicare nationwide, subject to Medicare’s payment rules—there is no private plan network. For drugs, Original Medicare does not include outpatient prescription coverage unless you join a separate Part D plan. Many people also consider Medigap (Medicare Supplement) to help pay deductibles, coinsurance, and copays. Official basics are on Medicare.gov — Get started with Medicare.
If you are new to the alphabet of Parts A–D, our Medicare Advantage made simple article walks through how the pieces fit together before you compare paths.
Medicare Advantage is the name for Part C. If you have Part A and Part B, you can join a Medicare Advantage Plan offered by a Medicare-approved private company that must follow rules set by Medicare. These plans are another way to get your Part A and Part B benefits—not an add-on on top of Original Medicare for daily medical coverage.
Most Medicare Advantage plans include prescription drug coverage (Part D). Plans often bundle extra benefits that Original Medicare does not include (such as dental, vision, or fitness programs), but extra benefits vary by plan and year—read the plan’s Evidence of Coverage for anything you count on. Overview: Medicare.gov — Medicare Advantage & other health plans.
For how Part C fits SJM Cares’ focus locally, see our Medicare Advantage overview. If you have both Medicare and Medicaid, a D-SNP may be relevant—start with D-SNP plans and our what is a D-SNP guide.
This table is a simple comparison. Your costs, networks, and drug rules still depend on the specific plan (for Medicare Advantage) or the specific Part D or Medigap choices (for Original Medicare).
| Topic | Original Medicare (Parts A & B) | Medicare Advantage (Part C) |
|---|---|---|
| Who runs it | Federal Medicare program | Private insurers that contract with Medicare |
| How you get care | Any doctor or facility that accepts Medicare, nationwide | Network rules (HMO, PPO, etc.); out-of-network care may cost more or not be covered except in emergencies |
| Drug coverage | Not included for most outpatient drugs—join Part D separately | Most plans include Part D |
| Typical extra benefits | Not built in—some people buy Medigap for cost help | May include extra benefits (varies by plan); still read limits in plan documents |
| Out-of-pocket limit | No Medicare cap on your share for Parts A and B—Medigap may help | Plans must include a yearly maximum out-of-pocket limit for covered Part A and B services (amounts vary by plan) |
| Travel | Often simpler if you spend time outside NYC and see Medicare providers | May be more restrictive outside the plan’s service area—check rules before you travel long term |
Medicare states that Medicare health plans (including Medicare Advantage) are another way to get Part A and Part B instead of Original Medicare. Source: Your health plan options.
Original Medicare: Most people do not pay a monthly premium for Part A if they or a spouse paid Medicare taxes long enough. Part B has a standard monthly premium and an annual deductible; after the deductible, you typically pay coinsurance (often 20% for many Part B services) for Medicare-approved services. CMS announces Part A and Part B premiums and deductibles each fall. For 2026, the standard monthly Part B premium is $202.90 and the annual Part B deductible is $283, per the CMS fact sheet 2026 Medicare Parts A & B Premiums and Deductibles. Higher incomes can pay more—see that same official source for income-related amounts.
Medicare Advantage: You still keep Part A and Part B and must keep paying your Part B premium (unless your state or another program helps you pay it). The plan may charge an additional premium or may offer a $0 plan premium in some areas—but $0 premium does not mean zero costs. You may still have copays, coinsurance, and a MOOP (maximum out-of-pocket) up to the plan’s limit for covered services. Drug costs depend on the plan’s Part D design. Always compare your drugs and doctors when you look at price.
Plans and allowed amounts change each contract year. Use Medicare Plan Compare for the year you are shopping.
With Original Medicare, you generally look for providers who accept Medicare and whether they accept assignment (which affects what you may be billed). That can matter in Brooklyn, Manhattan, Queens, the Bronx, and Staten Island if you want flexibility across boroughs or if you split time between NYC and another state.
With Medicare Advantage, plans usually use networks. An HMO-style plan may require a primary care doctor and referrals for specialists unless the plan says otherwise. A PPO may let you go out of network at a higher cost. Before you enroll, search the plan’s provider directory for your primary care doctor, specialists, hospitals, and labs—directories can change during the year.
Stock photo for illustration only—not a specific plan, provider, or enrollment situation.
If you need Medicaid and Medicare together, networks and cost sharing can look different than for someone on Medicare alone—see D-SNP plans and official Medicaid resources for New York.
Need help choosing a path? Call SJM Cares at (347) 696-6757 for a free, no-obligation conversation with a licensed Medicare advisor who works with Brooklyn and NYC beneficiaries.
Original Medicare members usually join a standalone Part D plan unless they have other creditable drug coverage. Each Part D plan has its own drug list (formulary), tiers, and rules (such as prior authorization).
Medicare Advantage plans usually include Part D (MA-PD). The same formulary and utilization rules apply in concept, but each plan’s list is different.
For any path, make a list of your prescription names, doses, and pharmacies (including mail order if you use it). Enter them in Medicare Plan Compare to reduce surprises after enrollment.
Medigap helps pay some out-of-pocket costs under Original Medicare. Medicare Advantage is not Original Medicare for how claims are paid day to day.
Medicare is clear: when you are getting started, you can either buy Medigap or enroll in a Medicare Advantage Plan, but you can’t have both. You can’t use Medigap to pay Medicare Advantage copayments, deductibles, and premiums. If you want to switch toward Original Medicare and buy Medigap, you must follow Medicare and state rules about disenrolling—rights to buy a Medigap policy vary by state and situation. Read the official wording on Learn how Medigap works.
- Confirm you have Part A and Part B (or know your effective dates) before choosing Medicare Advantage.
- List your providers and prescriptions; check networks and formularies for the plan year.
- Compare total expected costs, not only the premium—including copays, MOOP, and drug tiers.
- Review election periods. Fall Open Enrollment is October 15–December 7 each year for many changes; other periods apply for special situations. Our AEP vs OEP vs SEP for NYC post summarizes the main windows with links to Medicare.
- Use official tools first, then talk with a licensed advisor or SHIP for your specific case.
Our Medicare enrollment checklist can help you stay organized.
You do not have to sort this out alone.
- SHIP (State Health Insurance Assistance Program) offers free, unbiased Medicare counseling. Use SHIP Help in your state to find New York’s program.
- Medicare.gov and 1-800-MEDICARE are the official sources for enrollment rules and plan listings.
- SJM Cares explains options among plans we are appointed to offer in your area and can coordinate with your questions—see Community Resource Hub for broader NYC-facing links.
Original Medicare is Part A and Part B through the federal program, with wide provider access if providers accept Medicare. Medicare Advantage is Part C: you still have Medicare, but a private plan delivers Parts A and B (and usually Part D) with plan-specific networks, costs, and rules. Compare using your health plan options on Medicare.gov.
You remain enrolled in Medicare. You use the Medicare Advantage Plan to get your Part A and Part B benefits instead of receiving them directly as Original Medicare for covered services, subject to the plan’s rules. Marketing should never sound like the government endorsed a specific plan—verify details in official documents.
Maybe. Medicare Advantage plans use networks. Before you enroll, confirm your doctor participates in that plan for the dates you need care. If you need out-of-network care, you may pay more or not be covered except in limited cases (such as emergencies), depending on plan type.
Most Medicare Advantage plans include Part D. Check the plan’s formulary for your medications. If you have a plan without drug coverage, you may need another creditable drug plan—ask how that works before you enroll.
Sometimes, during certain election periods or if you qualify for a Special Enrollment Period. If you return to Original Medicare, you may want Part D and may try to buy Medigap—Medigap rules vary by state, and you may face medical underwriting outside protected rights. Use Medicare’s pages on when you can join, switch, or drop a plan and Medigap rights.
There is no single answer for every person. It depends on your doctors, health needs, budget, prescriptions, and whether you travel. Compare plans in your ZIP code for the year you are enrolling and read the Summary of Benefits and Evidence of Coverage. Free help is available through SHIP and through licensed brokers for the products they offer.
Choosing between Medicare Advantage and Original Medicare is a personal decision. SJM Cares helps Brooklyn and NYC residents understand Part C, D-SNP, and related options in clear language—no pressure, just education and next steps that fit your situation.
Call us at (347) 696-6757 or schedule an appointment online. You can also contact us here.
Written by Hamad Amir, licensed insurance agent and founder of SJM Insurance Services, LLC. Licensed in New York and New Jersey (License #LB-1024797). Specializing in Medicare Advantage and D-SNP plans for Brooklyn and NYC residents.
Hero and inline photos are stock images from Unsplash for illustration only; they do not depict a specific plan, carrier, or client.
Disclaimer: This article is for educational and informational purposes only and does not constitute professional insurance, financial, or legal advice. For personalized guidance, call a licensed SJM Cares advisor at 917-373-0117.
We do not offer every plan available in your area. Currently we represent 10 organizations which offer Medicare Advantage HMO, PPO, PFFS, and PDP plans in your area. Please contact Medicare.gov, 1-800-MEDICARE (TTY: 1-877-486-2048), or your local State Health Insurance Assistance Program (SHIP) to get information on all of your options.
Not connected with or endorsed by the United States Government or the federal Medicare program. This is a solicitation for insurance.