Medicare Advantage vs Original Medicare

Overview: Two Different Approaches

Original Medicare is the traditional government-run program that consists of Part A (hospital insurance) and Part B (medical insurance). It's been the cornerstone of senior healthcare since 1965 and provides coverage anywhere in the United States where Medicare is accepted.

Medicare Advantage (also called Medicare Part C) is an alternative way to get Medicare benefits through private insurance companies approved by Medicare. These plans must provide at least the same coverage as Original Medicare but often include additional benefits and different cost structures.

Detailed Coverage Comparison

What's Covered

Cost Comparison

Medicare Advantage Costs

• Monthly Premium: Many plans available for $0, some have monthly premiums
• Deductible: Varies by plan, often lower than Original Medicare
• Copayments: Fixed amounts for services (e.g., $20 for doctor visit)
• Out-of-pocket Maximum: Annual limit on your spending (not available with Original Medicare)
• Network Restrictions: Generally must use plan's network providers

Original Medicare Costs

• Part B Premium: $174.70/month for most people in 2024
• Part B Deductible: $240 annually in 2024
• Coinsurance: Typically 20% of Medicare-approved amounts
• No Out-of-pocket Maximum: Unlimited potential costs
• Supplement Insurance: May need Medigap policy for additional protection

Provider Networks and Flexibility

Medicare Advantage Networks

Most Medicare Advantage plans use provider networks, meaning you'll generally need to use doctors and hospitals that are "in-network" to get the lowest costs. This can limit your choice of providers but often results in better care coordination.

Original Medicare Freedom

With Original Medicare, you can see any doctor or specialist who accepts Medicare assignment anywhere in the United States. There are no networks to worry about, giving you maximum flexibility in choosing your healthcare providers.

Extra Benefits: Where Medicare Advantage Shines

One of the biggest advantages of Medicare Advantage plans is the inclusion of benefits that Original Medicare doesn't cover:

Prescription Drug Coverage

Medicare Advantage

Most Medicare Advantage plans include prescription drug coverage (Part D) built right into the plan. This means one plan, one premium, and coordinated care between your medical and pharmacy benefits.

Original Medicare

Original Medicare doesn't include prescription drug coverage. You'll need to enroll in a separate Part D prescription drug plan, which means an additional monthly premium and dealing with multiple insurance plans.

When Medicare Advantage Makes Sense

Medicare Advantage may be a good choice if you:

• Want all-in-one coverage with potentially lower costs
• Value extra benefits like dental, vision, and wellness programs
• Are comfortable using network providers
• Want predictable costs with copayments instead of coinsurance
• Appreciate care coordination and case management
• Live in an area with good Medicare Advantage plan options
• Want an annual out-of-pocket maximum for budget protection

When Original Medicare Makes Sense

Original Medicare may be a better choice if you:

• Want the freedom to see any Medicare-accepting provider
• Travel frequently or live in multiple states
• Have established relationships with specialists
• Don't mind managing separate policies for different benefits
• Want the security of government-administered benefits
• Are willing to purchase Medigap insurance for additional protection
• Prefer the traditional fee-for-service model

Making Your Decision

The choice between Medicare Advantage and Original Medicare depends on your individual circumstances, including: