What’s the Difference Between Original Medicare and Medicare Advantage?

Jul 18, 2019

Becoming eligible for Medicare is exciting! We hear about it all our lives—that one day we’ll benefit from government-sponsored healthcare.

But did you know that you have many Medicare options available to you, starting with Original Medicare and Medicare Advantage?

Instead of just settling for Original Medicare, it’s vital to empower yourself on all your options, to ensure you’re paying a good price for all the healthcare benefits you need.

This post makes it easy to make that sound decision. Keep reading to learn the difference between Original Medicare and Medicare Advantage, and to get peace of mind on all your health care choices.

What is Original Medicare?

Original Medicare, or Medicare Part A and Medicare Part B, cover basic inpatient and outpatient services.

  • What it covers: Basic care, including:
    • Doctor’s visits
    • In-patient hospital care
    • Nursing care
    • Home health care
    • Hospice care
    • Chemotherapy
    • Certain tests, lab work and medical equipment
  • Who provides it: The federal government. You can receive care from any doctor that accepts Medicare.
  • How to get it: You have seven months to sign up for Original Medicare. Initial enrollment for Medicare starts three months before you turn 65, includes your birthday month and runs for three months after.
  • What it costs You pay 20% of the visit cost (coinsurance).

What is Medicare Advantage?

Medicare Advantage, also known as Medicare Part C or MA, are plans that cover more than Original Medicare.

To get an understanding of this Medicare option, here’s what you should know:

  • What it covers: Medicare Advantage coverage is more comprehensive than Original Medicare. However, the specifics depend on the plan. For example, some plans may cover inpatient and outpatient care, plus:
    • Prescription drugs
    • Dental
    • Vision
    • Hearing
  • Who provides it: Private insurers that are approved by Medicare. The federal government also regulates MA plans.
  • How to get it: To have Medicare Part C, you still need Medicare Part A and Part B and must pay the Part B premium (which is a standard of $135.50 in 2019). You can only sign up during the enrollment period (October 15 – December 7).
  • What it costs: You may pay a premium (fixed cost) which will depend on the plan, but know you’ll also need to keep paying your Part B premium to remain eligible for a Part C plan.

Medicare vs. Medicare Advantage

Understanding the difference between Original Medicare and Medicare Advantage will really depend on your current situation. You can start by comparing the benefits.

Original Medicare Pros:

  1. There’s a set copayment and/or coinsurance to pay for covered services (private insurers set this for MA).
  2. Not restricted to certain providers and no need for specialist referrals.
  3. Standard across anywhere that accepts Medicare (MA plan eligibility may have geographic restrictions).

Pros of Medicare Advantage:

  1. More coverage options, which often includes prescription drug coverage and may include coverage outside the country.
  2. There’s a cap to the out-of-pocket expense you can incur (unlike Original Medicare). Once you reach this, your plan will pay for your health costs instead of you.

How Do I Know What’s Right For Me?

Choosing a plan isn’t final. The good news is that you can always switch between plans during the yearly enrollment period. But when it comes to getting the best health care you need right now, approach the decision like any major purchase: do your research to make a well-informed decision.

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