Medicare Advantage vs. Original Medicare

Choosing between Original Medicare and Medicare Advantage is an important decision when you become eligible for Medicare. That’s because the differences between Original Medicare and Medicare Advantage can affect both your costs and your coverage. The choice you make can impact how much you pay for premiums, copays, and out-of-pocket expenses—as well as which doctors and hospitals you can use. Taking the time to learn how each option works can help you avoid unexpected costs and choose coverage that best fits your health needs and budget.

Original Medicare includes Part A (hospital stays) and Part B (doctor visits). With Original Medicare, you can go to any doctor or hospital that accepts Medicare, but it does not cover everything. For example, it doesn’t include prescription drug coverage. For that, you will need to enroll in a separate Part D plan.

Medicare Advantage (Part C) covers everything that Original Medicare covers, plus extra benefits like dental, vision, and hearing. It also often includes prescription drug coverage. With Medicare Advantage plans, you may have to use a network of doctors and hospitals covered by the plan or pay higher costs for out-of-network care.

Read on to learn more about each option and what it can mean for things like how you get your medical care and how much you might pay out-of-pocket.

What is Original Medicare?

Medicare is a federal insurance program for people 65 and older or those with disabilities or end-stage renal disease. The two main parts are:

Medicare Part A: Covers inpatient hospital stays, stays in a skilled nursing facility, hospice care, and some home health care. Most people do not pay a premium for Part A if they or their spouse paid Medicare taxes while working. 

Medicare Part B: Covers doctor’s office visits, outpatient care, medical supplies, and preventive services. Most people pay a monthly premium for Part B. There is also a deductible. After the deductible is met, Medicare pays 80 percent for covered services. 

Original Medicare does not cover everything. It does not include routine dental, vision, or hearing, and it does not cover prescription drugs. Members often need to purchase additional coverage, like a Medicare Part D drug plan or Medicare Supplement insurance (Medigap) to help with out-of-pocket costs for deductibles, copays, and coinsurance. 

What is Medicare Advantage?

Medicare Advantage is Medicare coverage offered by private insurance companies. It combines your Part A (hospital), Part B (doctor), and sometimes Part D (prescription drugs) coverage into one plan. It also includes other benefits not covered by Original Medicare like dental, vision, hearing, fitness programs, and an allowance for over-the-counter (OTC) products. 

Members still pay the Part B premium and may have additional premiums, copays, and coinsurance. However, Medicare Advantage plans still may offer lower out-of-pocket costs from Original Medicare. Medicare Advantage plans often have a maximum out-of-pocket to limit yearly spending for covered services. 

 

Differences between Medicare Advantage and Original Medicare plans

Pros and cons of Medicare vs. Medicare Advantage

Your health care decision is important because it affects where you can get care and how much you may pay. Ultimately, the decision between Original Medicare or Medicare Advantage will come down to each person and their unique needs.

Below are the advantages and drawbacks of Original Medicare and Medicare Advantage to help you understand how they differ and help you choose the coverage that best meets your needs, budget, and lifestyle.

Original Medicare

Advantages:

• Freedom to see any doctor or hospital that accepts Medicare
• No provider networks, which can be helpful if you travel often or live in more than one state
• Predictable coverage for hospital and medical services
• Can add separate coverage, like a Medigap plan, to help with out-of-pocket costs

Drawbacks:

• Does not include routine dental, vision, or hearing coverage

• Does not include prescription drug coverage—you will need to enroll in a separate Part D plan

• No cap on annual out-of-pocket costs

• Monthly costs may be higher when combining Part B, Part D, and Medigap premiums

Medicare Advantage

Advantages:

• Includes everything Original Medicare covers, plus extra benefits
• Vision care, including eye exams and glasses
• Dental care, including cleanings and dentures
• Hearing care, including hearing aids
• Prescription drugs (Part D)
• An allowance for over-the-counter (OTC) drugs
• Wellness programs and gym memberships
• Often has lower monthly premiums than combining Original Medicare with Medigap
• Has a yearly out-of-pocket limit to help protect you from unexpected costs

Drawbacks:

• May require you to use a network of doctors and hospitals
• Out-of-network care may cost more or may not be covered, except in emergencies
• Plan benefits, costs, and networks can change from year to year