Original Medicare vs Medicare Advantage

Reviewed and Updated by Kelsey Davis,

The Annual Enrollment Period is quickly approaching and starting October 15, you are able to switch your Medicare coverage. Which do you favor in the battle of Original Medicare vs Medicare Advantage? If you’re not quite sure, we’re here to help! By understanding the basic principles of each option you will be better prepared to make that decision.

What is Original Medicare?

Created in 1965, Original Medicare is a federally-regulated healthcare program designed largely for senior citizens. Original Medicare includes Part A (hospital coverage) and Part B (medical coverage). Part A covers inpatient and outpatient care at hospitals, nursing homes, hospice care, and home health services. Part B covers doctor visits and ambulance rides. Most beneficiaries receive Part A for free. Most people pay the same rate for Part B coverage, but a small number of beneficiaries may have income-adjusted premiums.

Original Medicare allows beneficiaries to go to any provider that accepts Medicare, which is over 900,000 physicians nationwide! This means that no matter which Medicare provider you visit, the costs will stay the same. This is ideal for beneficiaries who travel often or want doctors in different locations.

If you are enrolled in Original Medicare, you are able to enroll in a Medigap plan. Medigap plans provide financial benefits for an extra monthly premium. This can include help paying your copayments, coinsurance, and deductibles. Additionally, some of these Medigap plans cover prescriptions drugs. However, if your plan does cover prescription drugs, you cannot purchase a separate drug plan.

What is Medicare Advantage?

Medicare Advantage plans were not offered until 2003. Since then, enrollment has tripled to 19 million beneficiaries according to the Henry J Kaiser Family Foundation. Medicare Advantage plans are available through private insurance companies and must cover the same benefits as Original Medicare. However, many MA plans offer extra benefits like vision and dental coverage and even SilverSneakers®. These plans have a set network of providers you must choose from, but don’t worry! There are many different networks and plans available.

Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs) are the most popular plans among Medicare Advantage.

HMOs:

An HMO is a closed provider network. Your primary care provider must fall into this network. Additionally, you must use this network in the event of an emergency. HMOs may require you to get a referral for more severe injuries or illnesses.

PPOs:

PPOs allow you to see any doctor, but staying in your network you will save you money. Additionally, they don’t require referrals and like HMOs, they often cover Part D supplements.

Medicare Advantage plans have one monthly premium. There is no hassle with sending payments for multiple plans. Some MA plans may offer a lower deductible in exchange for a higher monthly premium. This is a great option for healthy seniors. With MA plans, you only pay for the services you use rather than paying a higher upfront cost.

Differences between Original Medicare and Medicare Advantage

It is easy to confuse Original Medicare and Medicare Advantage. By understanding a few key differences you will be able to better evaluate which option is best for you.

Out of Pocket Costs

Original Medicare has no set limit for how much you will spend out-of-pocket. This means that if you need more medical attention for any given reason, you may exceed what you budgeted. However, Medicare Advantage plans have a maximum out-of-pocket limit. Once you reach this limit on out-of-pocket costs for covered services, your costs will be covered for the remaining calendar year. It is important to note that some Medicare Advantage offers lower limits- that means more money saved for you!

Health Questions

Original Medicare plans require you to answer numerous health questions. However, Medicare Advantage plans do not require any health questions. The only question they can ask you is if you have end-stage renal disease. Medicare Advantage plans will not cover this disease because the Center for Medicare and Medicaid Services (CMS) defines end-stage renal disease as “permanent kidney failure that requires a regular course of dialysis or a kidney transplant.”

Supplemental Insurance

You can not purchase a Medigap plan and a Medicare Advantage plan. You must choose one or the other. Medigap coverage helps fill in the gaps that Original Medicare doesn’t fill. However, Medicare Advantage plans allow you to get a more customized plan that gives you the benefits you need for your budget.

Extra Services

With Original Medicare, you get what you get. With Medicare Advantage plans, you get what you want. Original Medicare does not cover extra services, however, MA plans may allow you to get additional vision and dental coverage and group fitness classes.

Providers

As previously mentioned, there are over 900,000 physicians nationwide that accept Medicare coverage.  Medicare Advantage plans require you to stay within the plan’s network. If you go out of your network there may be a significant price increase. If you traveling and are rarely in the same area, this may not be the best option for you.

Part D Coverage

Original Medicare is only Part A and B. If you want prescription drug coverage, you must purchase Plan D through a private provider or a Medicare Advantage plan.

Pros of Medicare Advantage

Throughout this article, there may have been a few pros of Medicare Advantage plans that caught your attention. In case you missed anything, we’ve compiled a list of the top reasons you should consider purchasing a Medicare Advantage plan.

Potential Lower Costs

Although you pay a premium with both Original Medicare and Medicare Advantage, MA plans may offer a lower deductible in exchange for a higher monthly premium. Also, MA plans have the maximum-out-of-pocket limit, saving you even more in the long run!

Prescription Drugs

Drug coverage is often included in Medicare Advantage plans. This allows you to bundle your coverage – saving you money and creating more convenience for you!

Additional Coverage

Medicare Advantage plans offer extra coverage that Original Medicare cannot. If you’re looking for vision, hearing, or dental coverage – an MA plan may be right for you!

Maximum Flexibility

Medicare Advantage plans include the benefits you want and need. The plans are flexible and ensure you get the coverage and the cost that fits your budget.  

Get covered today!

Does a Medicare Advantage plan look attractive to you? Did we grab your attention? AEP is coming soon! From October 15 to December 7 you are able to make changes to your Medicare coverage. If you’re interested in purchasing a Medicare Advantage plan or hearing more about coverage options available to you, complete this form or call us at 833-438-3676 to arrange a no-obligation appointment with an agent.

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