What’s the difference between Medicare Advantage and Original Medicare?

Updated November 22, 2019 Chance Rueger is a Medicare sales agent licensed to sell in 50 states

By far the most common thing I get asked is to compare and contrast the differences between Medicare Advantage and Original Medicare, or similarly, people will often question the difference between Medicare Advantage and Medicare Supplement.

The Basics

Original Medicare = Parts A & B

·         Original Medicare is what many people associate with the “government covered” portion of Medicare

·         This generally covers 80% of your costs

·         You are responsible for the other 20%. And it is important to note that there really is no cap or limit on how high this 20% can be

·         This does not cover prescription drugs

I strongly recommend getting additional coverage to fill in this 20%. And for this, there are basically two options:

Medicare Advantage = Part C

·         Medicare Advantage replaces Original Medicare.

·         The coverage is at least as good as what Original Medicare provides

·         Medicare Advantage has cost sharing, i.e. deductibles, copays, and coinsurances. There is a maximum out-of-pocket limit.

·         Medicare Advantage plans generally have low premiums – some of these plans even have $0 monthly premium

·         These plans have networks of doctors that you need to stay within. This is often the most important thing for people to learn and understand.

·         Many plans include prescription drugs coverage

·         Even though you are technically “replacing” Original Medicare with a Medicare Advantage plan, you still need to pay the Part B premium

Medicare Supplement = Medigap

·         Medicare Supplement works with Original Medicare

·         These plans supplement Original Medicare to fill in the 20% gap (which is also why they are commonly referred to as ‘Medigap’ plans)

·         There are very little or even $0 out-of-pocket expenses when you receive care

·         Medicare Supplement plans typically have more expensive monthly premiums, on average about $150-$300 per month

·         You can see any doctor who accepts Original Medicare; unlike Medicare Advantage plans that have limited networks

·         Does not include prescription drugs coverage – you need to buy another policy for that

·         You still need to pay the Part B premium

The Trade Offs

Cost

·         Medicare Advantage: though the monthly premiums are very low, you will have to pay when you receive care. You also still need to pay the Part B premium. So if you go to the doctor frequently, the costs for Medicare Advantage can add up.

·         Medicare Supplement: you’ll pay more in monthly premium, but very little when you receive care. You also still need to pay the Part B premium.

Doctor Network

·         Medicare Advantage: you need to stay in your plan’s network.

·         Medicare Supplement: you can see any doctor who accepts Medicare.

Prescription Drugs

·         Medicare Advantage: included.

·         Medicare Supplement: not included.

Plan Variety

·         Medicare Advantage: plans vary dramatically, there is no standardized structure to them.

·         Medicare Supplement: the plans – in terms of what they cover – are standardized by government. In other words, for example, what Plan G covers is identical no matter which company you buy it from.

Which is better?

There is no easy answer to this as it really depends on your personal situation. Medicare Supplement works great for some people. Medicare Advantage is great for some people.

If you twist my arm…

I’d say go with Medicare Supplement. Your costs are much more predictable and you can (for the most part) see any doctor you like.

In the worst case scenario here, let’s say you’re really healthy, and therefore just paid more premium than you would have liked. To me, this is much better than the alternative situation of being tempted by the less expensive monthly premium option that a Medicare Advantage plan might offer, only to then spend a lot of money on copays, deductibles, and coinsurances if you make lots of trips to the doctor.

That’s how insurance works––you pay money for something you hope you never use!

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