Abstract-Modular multilevel converters are increasingly being considered or used for various medium voltage applications. Multiple control methods have been proposed for the control of the direct to three-phase modular multilevel converter. They differ one from another in the way the capacitor voltage ripples are handled, i.e. either neglected, estimated, reconstructed by filtering or measured. This has implications on the performance level that can be obtained. This paper provides insights on the advantages and drawbacks of each control method, in inverter and rectifier mode, with a fair and thorough assessment supported by extensive simulations, with converter ratings that are realistic for medium voltage applications. Finally, this works highlights the impact of the higher dynamics for medium voltage dc applications compared to high voltage dc ones on the choice of the control method.