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Medicare Advantage vs Original Medicare

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Original Medicare and Medicare Advantage (Medicare Part C) are two ways to get your Medicare benefits. Learn the differences between these two ways to get Medicare coverage.

Original Medicare vs Medicare Advantage: How are they administered?

Original Medicare and Medicare Advantage offer some of the basic benefits (hospital insurance and medical insurance) but are administered in different ways by different entities.

Original Medicare vs Medicare Advantage: Who is eligible? To be eligible for Original Medicare, you must be a U.S. citizen or permanent legal resident of at least five continuous years AND

  • be age 65 or older or
  • be permanently disabled and receive disability benefits for at least two years or
  • have end-stage renal disease (ESRD) or Lou Gehrig’s disease (ALS).

To be eligible for Medicare Advantage, you must first be eligible for Medicare. In addition, you must be enrolled in Medicare Part A and Part B and live in the service area of the plan you wish to enroll in. One last requirement is that you must not have end-stage renal disease, however there are some exceptions. People with end-stage renal disease may be able to enroll in a Medicare Advantage Special Needs Plan.Original Medicare vs Medicare Advantage: How are the benefits different? Original Medicare has two parts. Medicare Part A covers hospital inpatient care, skilled nursing facility care and hospice care. Medicare Part B covers doctor visits, other outpatient care, and durable medical equipment, such as wheelchairs.Medicare Advantage plans must cover everything that Original Medicare covers. Medicare Advantage plans may also cover additional benefits that Original Medicare generally doesn’t cover such as:

  • prescription drug coverage
  • routine dental care including cleanings, fillings, and root canals
  • routine vision care including eyeglasses
  • routine hearing care including hearing aids
  • fitness benefits
  • advice nurses

Original Medicare vs Medicare Advantage: How are the costs different?  Original Medicare vs Medicare Advantage: Can I see the same doctors? If you have Original Medicare, you can see any doctor that accepts Medicare assignment. However if you have a Medicare Advantage plan such as a Health Maintenance Organization (HMO) you may be required to get your health care from providers in the plan’s network. Keep in mind that if you need emergency care, you can go to any doctor or hospital without being turned away.Original Medicare vs Medicare Advantage: What are other differences? Original Medicare works with Medicare Supplement plans which help pay Medicare out-of-pocket expenses, such as copayments, coinsurance, and deductibles. Medicare Part D, prescription drug coverage, can work with both Medicare Advantage and Original Medicare.If you have Original Medicare, you may be eligible to buy a Medicare Supplement plan to help you cover various out-of-pocket costs such as copayments, coinsurance, and deductibles. A Medicare Supplement plan may also cover some emergency care during foreign travel. A Medicare Supplement plan only works with Original Medicare; you cannot use it together with Medicare Advantage.If you have Original Medicare and want prescription drug coverage, you can get a stand-alone Medicare Part D Prescription Drug Plan. If you have Medicare Advantage, you can also a join stand-alone Prescription Drug Plan with certain types of plans that don’t offer prescription drug coverage. However, if you’re enrolled in a Medicare Advantage HMO or PPO and join a stand-alone Medicare Prescription Drug Plan, you could be automatically disenrolled from Medicare Advantage and returned to Original Medicare.Are you interested in the prices of Medicare Advantage plans in your area? Just enter you zip code on this page to begin comparing plans.

Plan Types Administered By Costs and Benefits
Original Medicare U.S. federal government Generally the same from state to state
Medicare Advantage plans Private insurance companies Vary from plan to plan and area to area
  Original Medicare Medicare Advantage
Premiums Most people don’t pay a premium for Medicare Part A. However, if you not eligible for premium-free Part A, you may have to pay a Part A premium. Most people do pay a premium for Medicare Part B. You still have to pay your Medicare Part B premium with a Medicare Advantage plan. People who are not eligible for premium-free Part A may have to pay a Part A premium. The Medicare Advantage plan may also charge an additional monthly premium. Some Medicare Advantage plans have a $0 premium.
Deductibles Medicare Part A and Part B both have deductibles which may increase year to year Some Medicare Advantage plans have no deductible
Coinsurance/copayments Medicare Part A and Part B both have coinsurance amounts for most services other than preventative care, a “welcome to Medicare” visit and yearly “wellness” visits You usually pay a $0 copay for preventive care for Medicare Advantage. You usually pay a copayment for primary care doctor visits, specialist visits, emergency room visits, ambulance services, and more. The copayment amounts can vary from plan to plan
Out of pocket maximum Original Medicare has no out of pocket maximum Medicare Advantage plans have out-of-pocket maximums. This means that once you’ve paid this amount, your covered medical expenses will paid for the rest of the year.
Works with: Original Medicare Medicare Advantage Plans
Medicare Supplement plans Yes No
Part D Prescription Drug coverage Yes Yes

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