What Is the Difference Between Original Medicare and Medicare Advantage?

Posted by Medicare Made Clear Tue, May 28, 2019 @ 02:21 PM

Original Medicare (Parts A & B) and Medicare Advantage (Part C) are two different ways to get Medicare benefits.

It’s important to learn about Original Medicare and Medicare Advantage because you get to choose which way you want to get your benefits. Both options provide the same basic level of hospital and medical insurance. But there are also differences between them.

Original Medicare vs Medicare Advantage

The table below gives a quick, side-by-side comparison of Original Medicare and Medicare Advantage. It shows similarities and differences in three important areas:

• Coverage
• Cost
• Care providers

The table and the tips that follow can help you focus on what’s important to you, so you can better weigh your options.

Original Medicare (Parts A & B)	Medicare Advantage (Part C)
What’s covered?
Inpatient hospital and skilled nursing services (Part A)	Inpatient hospital and skilled nursing services (Part A)
Doctor visits, outpatient services and some preventive care (Part B)	Doctor visits, outpatient services and some preventive care (Part B)
	Prescription drug coverage (Part D) included with most plans
	Extra benefits may include: Dental, vision, hearing care Fitness program Additional services, such as rides to the doctor and home safety devices
What does it cost?
Part B premium paid to Medicare; Part A is premium-free for most	Part B premium paid to Medicare; Part A is premium-free for most
Additional premium costs when Medicare supplement and Part D plans added	Low or $0 plan premium
Part A & B deductibles; 20% Part B coinsurance; copays for some services	Plan may have deductible; copays for most services
No limit on out-of-pocket costs (deductibles, coinsurance, copays)	Yearly limit on out-of-pocket costs (deductibles, coinsurance, copays)
	Medicare sets maximum out-of-pocket limit; plan limits may be less than the maximum
What providers can you see?
Doctors and other providers in the U.S. who accept Medicare	Doctors and other providers in the plan network with most plans; may pay more outside the network
Limited coverage in foreign countries	Limited coverage in foreign countries
	Emergency and urgent care covered nationwide

5 Tips to Help You Choose. Original Medicare or Medicare Advantage?

1.     Medicare Advantage plans cover everything Original Medicare covers plus more. Many plans cover prescription drugs and routine dental, vision and hearing care. So you get all your coverage in one plan.

2.     You may pay more copays with Medicare Advantage than with Original Medicare depending on the health care services you use.

3.     Medicare Advantage provides financial protection with an annual out-of-pocket limit. You can add protection to Original Medicare by buying a Medicare supplement plan.

4.     You could have higher monthly premium payments with Original Medicare than with Medicare Advantage, because you might want to add a Part D prescription drug plan and a Medicare supplement plan.

5.     Original Medicare covers care you receive from any provider who accepts Medicare. With most Medicare Advantage plans, you need to see providers who are in the plan network. Network providers agree to the plan’s negotiated prices so you get to take advantage of the cost savings.

Can You Switch Between Original Medicare and Medicare Advantage?

Yes, you can switch from Original Medicare to Medicare Advantage or vice versa. The two main times you can switch are the Medicare Annual Enrollment Period and during certain Special Enrollment Periods.

For more information about Medicare, explore MedicareMadeClear.com or contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048.

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