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What is the difference between Original Medicare and Medicare Advantage?


There are two alternative ways to receive Medicare benefits: Original Medicare (Parts A and B) and Medicare Advantage (Part C). Both alternatives offer the same fundamental level of hospital and medical insurance, but they also have significant variances.

Original Medicare vs. Medicare Advantage

Understanding the variations in coverage, cost, and care provider requirements will help you choose the best option. To discover more about each in-depth, continue reading.

Medicare Advantage and Original Medicare are contrasted.

Medicare Parts A and BMedicare Advantage

includes both medical and hospital coverage (Part A) (Part B)

combines medical coverage (Part B) and extra health benefits with hospital coverage (Part A) under a single plan.

does not offer coverage for prescription medications

includes coverage for prescription drugs

doesn’t offer any additional health advantages

incorporate other health advantages including dental, eyesight, hearing, and fitness

the federal government offers

depending on the location and provider, provided by private insurance firms with varied advantages, rates, and coverage options.

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Original Medicare vs. Medicare Advantage: Coverage

Part A of Original Medicare pays for inpatient hospital and skilled nursing facility care, whereas Part B of Original Medicare pays for doctor visits, outpatient treatments, and some preventative maintenance.

All of the aforementioned (Part A and Part B) are covered by Medicare Advantage plans, and the majority of them also include prescription medicines (Part D). In addition, each Medicare Advantage plan provides additional benefits, which, while they differ by plan and provider, may cover things like dental, vision, and hearing insurance as well as fitness programs, transportation to doctor’s visits, and more.

Original Medicare vs. Medicare Advantage: Cost

You will probably have to pay premiums, deductibles, copays, and coinsurance whether you choose Original Medicare or a Medicare Advantage plan.

Costs with Original Medicare include:

  • The Part B premium
  • Part A premium1
  • Deductibles for Parts A & B
  • Part B Coinsurance
  • Copays for Parts A & B services
  • You’ll probably have to pay additional premiums, deductibles, copays, and coinsurance amounts if you add Part D prescription medication coverage.

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Costs with Medicare Advantage vary but may include:

  • The Part B premium
  • A low-cost or $0 plan premium
  • A plan deductible (not all Medicare Advantage plans have one)
  • Copays for covered health services and items

A note about financial protection: There is a cap on your out-of-pocket expenses with a Medicare Advantage plan, though, which is a fantastic benefit (deductibles, coinsurance, and copays). This can significantly lower the cost of your Medicare coverage. Original Medicare does not offer the same kind of monetary security.

Original Medicare vs. Medicare Advantage: Providers

What medical professionals can see is the last significant distinction to consider when deciding between Original Medicare and a Medicare Advantage plan.

With Original Medicare, you are free to visit any hospital, physician, or healthcare facility in the United States that accepts Medicare. However, your coverage is constrained when traveling abroad.

Most Medicare Advantage plans feature a network of doctors and other healthcare professionals you can use. Outside of the network of the plan, you’ll probably have to pay more. Emergency and urgent care, however, are covered everywhere. Although some plans might provide extra foreign coverage or travel advantages, you also have restricted coverage abroad.

Tips to help you choose between Original Medicare or Medicare Advantage?

1. Consider if you want coverage for dental, vision, and other extra benefits

A Medicare Advantage plan can be the best option if you desire coverage like dental, vision, or fitness because they include everything Original Medicare covers plus more.

2. Think about what your total costs could be

Depending on the insurance plan you select and the medical services you receive, your overall expenses will change. But bear the following in mind specifically while comparing which choice best suits your financial circumstances.

Medicare Advantage offers built-in financial protection. The annual out-of-pocket maximum allowed can help you keep your expenses in check.

If you have Original Medicare, your premiums can be higher. Because you might choose to add a Part D prescription drug plan or other extra coverage, you might have greater monthly premium payments with Original Medicare than with Medicare Advantage.

With Medicare Advantage, you might have to pay more copays than with Original Medicare. Your copays with a Medicare Advantage plan may be higher depending on the medical services and providers you utilize if in-network versus out-of-network costs differ.

Medicare Advantage offers a yearly out-of-pocket maximum as financial security. Purchasing a Medicare supplement plan will give your Original Medicare additional protection.

Because you might choose to add a Part D prescription medication plan and/or a Medicare supplement plan, your monthly premium payments with Original Medicare could be higher than those with Medicare Advantage.

3. Consider how often you leave home

Any healthcare facility across the nation that accepts Medicare is covered by Original Medicare. To avoid additional fees with the majority of Medicare Advantage plans, you must see providers who are part of the plan’s network. Network providers accept the negotiated prices in the plan, allowing you to benefit from the cost savings. If you travel frequently, think about how this can affect your Medicare coverage.

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Can you switch between Original Medicare and Medicare Advantage?

As the last point, you can transfer from Original Medicare to Medicare Advantage or vice versa no matter which choice you determine is best for you. The Medicare Annual Enrollment Period and the Medicare Special Enrollment Period for Qualifying Life Events, if you qualify, are the two main occasions you can switch.

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