What Is the Difference Between Original Medicare and Medicare Advantage?
Published by: Medicare Made Clear
Original Medicare (Parts A & B) and Medicare Advantage (Part C) are two different ways to get Medicare benefits. Both options provide the same basic level of hospital and medical insurance but there are also important differences between them.
It's important to learn about the differences in coverage, cost and care provider rules because these will impact how you decide which option is best for you. Read below to learn about each in detail below.
Original Medicare vs Medicare Advantage: Coverage
Original Medicare covers inpatient hospital and skilled nursing services – Part A - and doctor visits, outpatient services and some preventative care – Part B.
Medicare Advantage plans cover all the above (Part A and Part B), and most plans also cover prescription drugs (Part D). Additionally, Medicare Advantage plans each offer extra benefits, which while they vary by plan and provider, may include coverage for dental, vision, hearing, fitness programs, rides to doctor appointments and more.
Original Medicare vs Medicare Advantage: Cost
Whether you choose to go with Original Medicare or with a Medicare Advantage plan, you will likely pay premiums, deductibles, copays and coinsurance.
Costs with Original Medicare include:
The Part B premium
*The Part A premium (*only if you or your spouse did not work and pay Medicare taxes for 10 years.)
Deductibles for Parts A & B
Part B Coinsurance
Copays for Parts A & B services
Additional Part D costs – (If you add a Part D prescription drug plan, you’ll likely have to pay additional premiums, deductibles copays and coinsurance amounts.)
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: A really great benefit with a Medicare Advantage plan though is there is a limit on your out-of-pocket costs (deductibles, coinsurance and copays). This can really help keep your Medicare costs under control. Original Medicare does not provide any financial protection like this.
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Original Medicare vs Medicare Advantage: Providers
A final key difference to consider when choosing between Original Medicare and a Medicare Advantage plan is what health care providers you can see.
With Original Medicare you can go to any hospital and see any doctor or provider within the U.S. who accept Medicare. You do have limited coverage in foreign countries, though.
With Medicare Advantage, most plans have a network of doctors and providers you can see. If you go outside the plan’s network, it’s likely you’ll have to pay more to do so. However, emergency and urgent care are covered nationwide. You also have limited coverage in foreign countries, though some plans may offer special foreign coverage or travel benefits.
Tips to Help You Choose Between Original Medicare or Medicare Advantage?
Consider if you want coverage for dental, vision and other extra benefits.Medicare Advantage plans cover everything Original Medicare covers plus more, so if you want things like dental, vision or fitness benefits, a Medicare Advantage plan may be the right choice.
Think about what your total costs could be. Your total costs will vary based on the coverage you choose and the health services you use. But consider the below specifically when comparing which option fits your financial situation best.
You get built-in financial protection with Medicare Advantage. The annual out-of-pocket limit provided can help keep your costs under control.
Your premiums may be higher with Original Medicare. 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 or other additional coverage.
You may pay more copays with Medicare Advantage than with Original Medicare. Depending on the health care services and providers you use, your copays could be more with a Medicare Advantage plan if costs vary in-network versus out-of-network.
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.
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/or a Medicare supplement plan.
Consider how often you leave home. Original Medicare covers care you receive from any provider who accepts Medicare throughout the country. With most Medicare Advantage plans, you need to see providers who are in the plan network in order to avoid added costs. Network providers agree to the plan’s negotiated prices so you get to take advantage of the cost savings. If you travel a lot, consider how your Medicare coverage may work with this.
Can You Switch Between Original Medicare and Medicare Advantage?
As a final note, no matter which option you decide is right for you, 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 the Medicare Special Enrollment Period for qualifying life events, if you qualify.