Deciding between Original Medicare and a Medicare Advantage Plan is an important healthcare choice when you turn 65. While both provide Medicare coverage, there are some key differences between Original Medicare and Medicare Advantage Plans that you should understand.
This article will explain Original Medicare benefits, Medicare Advantage Plan coverage, how the two options compare in terms of costs and healthcare providers, and whether a Medicare Advantage Plan can replace Original Medicare. Read on for an in-depth look at the difference between Original Medicare and Medicare Advantage.
What is Original Medicare?
Original Medicare consists of Part A, which covers hospital and inpatient care, and Part B, which covers doctor visits and outpatient services. It is run directly by the federal government and lets you see any doctor or hospital that accepts Medicare nationwide. You pay a premium for Part B coverage.
With Original Medicare you can see any specialist you choose without referrals. It offers stable, continuous coverage and there is no yearly limit to what you have to pay out-of-pocket for covered care.
What are Medicare Advantage Plans?
Medicare Advantage Plans are offered by private insurance companies and provide your Medicare Part A and Part B coverage. Plans have contracted networks of doctors and hospitals you must use.
Many Medicare Advantage Plans offer extra benefits Original Medicare does not cover, like dental, vision and hearing. Most plans charge a monthly premium. Many also provide Medicare prescription drug coverage. Your out-of-pocket costs are typically lower and there is a yearly limit on what you pay for covered services.
Can a Medicare Advantage Plan Replace Traditional Medicare Plan?
If you enroll in a Medicare Advantage Plan, you are still in the Medicare program, but your coverage is provided through the Medicare Advantage Plan rather than Original Medicare. The plan replaces your Original Medicare benefits and is an alternate way to get your Medicare Part A and Part B cover.
You can go back to Original Medicare during open enrollment periods if you decide to switch back from a Medicare Advantage Plan. You’ll also want a Medicare Part D drug plan or Medicare Supplement Plan if you switch back to Original Medicare.
Original Medicare vs Medicare Advantage Plans: Key Differences
There are some significant differences between getting your coverage through Original Medicare vs enrolling in a Medicare Advantage Plan:
- Costs – Original Medicare has no annual limit on your costs. Medicare Advantage Plans limit your annual out-of-pocket costs for covered medical services.
- Providers – Original Medicare lets you use any doctor or hospital nationwide that accepts Medicare. Medicare Advantage Plans have restricted provider networks.
- Referrals – Original Medicare doesn’t require a referral to see specialists. Some Medicare Advantage Plans require referrals to see in-network specialists.
- Prescriptions – Only some Medicare Advantage Plans include drug coverage. Original Medicare requires a separate Part D Plan for drug coverage.
- Coverage – Original Medicare’s coverage is standardized nationwide. Medicare Advantage Plan benefits differ by plan.
- Travel – Original Medicare covers you everywhere in the U.S. Medicare Advantage covers you in the plan’s service area unless it’s an emergency.
Pros and Cons of Medicare Advantage vs Original Medicare
Medicare Advantage Pros
- Often has lower out-of-pocket costs
- Provides extra benefits not covered by Original Medicare
- Offers coordinated care and healthcare integration
- Includes prescription drug coverage with many plans
Medicare Advantage Cons
- More limited choice of healthcare providers
- May require referrals to see specialists
- Doesn’t cover you outside the plan’s service area
- Must check plan covers your medications
Original Medicare Pros
- Freedom to choose any doctor or hospital nationwide that accepts Medicare
- No referrals needed to see specialists
- Continuous coverage year to year
Original Medicare Cons
- No annual limit on your out-of-pocket costs
- No extra benefits like vision or dental
- No prescription drug coverage – need a separate Part D Plan
- Higher individual healthcare costs
Key Takeaways: Original Medicare vs Medicare Advantage
- Original Medicare is provided by the federal government; Medicare Advantage Plans are from private insurers
- Medicare Advantage Plans restrict your provider choice but have capped out-of-pocket costs
- Both cover the same services, but Medicare Advantage often includes extra benefits
- You can switch back to Original Medicare during open enrollment periods
- Compare both options to your health needs and budget when deciding
Knowing the differences between Original Medicare and Medicare Advantage can help you choose the best Medicare coverage for your personal situation.
We’re Here to Help
You do not have to spend hours reading articles on the internet to get answers to your Medicare questions. Give the licensed insurance agents at Manatee Insurance Solutions a Call at (352) 221-3779. You will get the answers you seek in a matter of minutes, with no pressure and no sales pitch. We are truly here to help.
Does a Medicare Advantage Plan replace Medicare?
No, a Medicare Advantage Plan does not replace Medicare. It is an alternative way to receive your Medicare benefits.
What is the difference between Original Medicare and Medicare Advantage?
Original Medicare is the traditional Medicare Plan that includes Part A (hospital insurance) and Part B (medical insurance). Medicare Advantage, also known as Medicare Part C, is an alternative to Original Medicare and is offered by private insurance companies. It combines Part A, Part B premium, and sometimes Part D (prescription drug coverage) into one plan.
Are there any premium costs for Medicare Advantage Plans?
Yes, most Medicare Advantage Plans have a monthly premium in addition to the premium you pay for Part B coverage. However, the amount can vary depending on the plan.
What is the Medicare Open Enrollment Period?
The Medicare Open Enrollment Period is a period of time each year when you can change your Medicare coverage. It usually occurs from October 15th to December 7th.
Do Medicare Advantage Plans offer the same Original Medicare Benefits?
Medicare Advantage Plans must cover all the same services that Original Medicare covers, but they may have different costs, deductible and additional benefits. It’s important to compare plans to see which one best meets your needs.
What services do Medicare Advantage Plans cover?
Medicare Advantage Plans may be able cover all medically necessary services and supplies, which include hospital stays, hospice care, doctor visits, preventive care, and more. They may also provide additional benefits such as dental, vision, and hearing coverage.
Can I use my current doctors and healthcare providers with a Medicare Advantage Plan?
Medicare Advantage Plans usually have a network of doctors and healthcare providers that you must use in order to receive the full benefits of the plan. However, some plans may allow you to use out-of-network providers at a higher cost.
How do Original Medicare and a Medicare Advantage work?
When you enroll in a Medicare Advantage Plan, you are still part of the Medicare program. The private insurance company you choose to enroll with will then provide your Medicare benefits instead of Original Medicare.
Can I switch from Original Medicare to a Medicare Advantage Plan?
Yes, you have the option to switch from Original Medicare to a Medicare Advantage Plan during certain enrollment periods. However, it’s important to review the plan details and consider your healthcare needs before making a decision.
Are prescription drugs covered under Medicare Advantage Plans?
Some Medicare Advantage Plans include prescription drug coverage (Part D) as part of their benefits. However, not all plans offer this coverage, so it’s important to check the specifics of each plan.