Traditional Medicare versus Medicare Advantage

Traditional Medicare versus Medicare Advantage—how do I know what is best for me?

It can be hard to know how to pick the best coverage for your needs but here are a few considerations to take into account:

• Under Traditional Medicare, you can visit any doctor or hospital that takes Medicare, anywhere in the U.S. whereas under Medicare Advantage, you will be limited to your plan’s network.
• Traditional Medicare generally does not require prior authorization for services or supplies whereas prior authorization is common in Medicare Advantage plans.
• Traditional Medicare pays for all covered services at Medicare allowed rates – it can result in fewer restrictions, and better, more comprehensive coverage, but it can be more expensive than Medicare Advantage.

Learn more about the differences between Traditional Medicare and Medicare Advantage.

How can I switch from Medicare Advantage back to Traditional Medicare?

If you find that Medicare Advantage (MA) is not the right fit for you, you have options to switch back to Traditional Medicare. If you joined a MA Plan during your Initial Enrollment Period, you can change to another MA Plan (with or without drug coverage) or go back to Traditional Medicare (with or without a drug plan) within the first 3 months you have Medicare Part A & Part B.

You can also switch from your MA plan back to Traditional Medicare during Medicare Open Enrollment (October 15 to December 7) or during the MA Open Enrollment Period (January 1 to March 31).

Learn more about switching from MA plans to Traditional Medicare.

How do I find a Part D plan that is right for me?

Under Traditional Medicare, Part D (drug benefit) is optional coverage and must be added separately. The majority of Medicare Advantage plans offer an option which includes Part D coverage.  

If you are choosing a Part D plan, it is important to review plan formularies to make sure that the specific drugs you take are covered. Plans will vary in which drugs they cover and how much they charge you for out-of-pocket costs. 

Note: Part D plans are required to cover most drugs in six “protected” classes, which includes antineoplastics (anti-cancer drugs) and immunosuppressants. If you are living with lung cancer or have had a lung transplant, you are likely using one of these drugs! This gives you flexibility to shop around to find the Part D plan that is right for you because all Part D plans should cover these drugs. But drugs for other lung conditions, like asthma and COPD, do not fall into the protected classes – so you should look extra closely to make sure your medications are covered.

In 2025, individuals enrolled in Part D plans cannot pay more than $2,000 in out-of-pocket costs for their medications. Only prescriptions filled at an in-network pharmacy will be included in the $2,000 out-of-pocket cap. Also new in 2025 is the Medicare Prescription Payment Plan, which will allow beneficiaries to pay their out-of-pocket prescription drug costs in monthly installments over the course of the plan year. 

Check out these 6 tips for choosing Medicare drug coverage from Medicare.gov. 

Be sure to check out the Medicare FAQ to learn more.