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Original Medicare Vs. Medicare Advantage

October 8, 2021

Deciding between Original Medicare vs. Medicare Advantage: Which One is Right for You?

When you are eligible for Medicare, you have two primary options. One is Original Medicare, which includes Part A and Part B. The other option is Medicare Advantage, known as Part C.

You can’t have Part C and Original Medicare. When you choose Part C, you are choosing to get your Medicare Part A and B coverage through the Medicare Advantage plan. That means you have to choose between them, which can be a challenge. This article will help you understand Original Medicare vs. a Medicare Advantage plan so you can choose the right one for your needs.

Difference Between Original Medicare and Medicare Advantage

Original Medicare is administered by the government and it can be used at any doctor in the U.S. who accepts Medicare. Generally, most folks get Part A for free and pay a monthly premium for Part B.

Original Medicare coverage will not vary depending on which state or area you live in. Your out-of-pocket costs, after your deductible, are generally 20% of the Medicare-approved costs for services. Original Medicare does not cover hearing, vision, or dental care. If you want prescription drug coverage, you have to add Medicare Part D and pay a separate premium.

Medicare Advantage is sold by private insurance companies who have a contract with the Federal government. Theremay be limitations on the medical providers you can use depending on where you live. Most Medicare Advantage plans include prescription drug coverage and additional benefits. You might be able to get vision coverage or a discount to a local health club.

Most importantly for many beneficiaries, Medicare Advantage has more predictable out-of-pocket costs. Instead of paying a percentage of the service cost, which is impossible to know in advance, you generally pay specific deductibles and copayments.

You can often get Medicare Advantage for the same cost as Original Medicare, although some Advantage plans cost more.

Is Original Medicare Better Than Medicare Advantage?

Like any choice, there are pros and cons of Medicare Advantage plans vs. Original Medicare. For instance, Medicare Advantage plans can be better for those who want more predictable out-of-pocket costs or are looking for additional benefits.

However, Original Medicare is better for those who travel frequently or use doctors who are not in the same medical network. You won’t need referrals to see specialists and being able to see any doctor you choose can bring peace of mind. You can make Original Medicare out-of-pocket costs easier to manage if you add a Medigap policy.

It’s important to think about your specific needs before you choose between Medicare Advantage and Original Medicare. Only you can decide which is best for your situation.

Cost Difference Between Original Medicare and Medicare Advantage

When you have Original Medicare, you’ll pay a monthly premium for Part B and there is also a deductible each year. If you need prescription drugs, you may need Part D as well..

Once you reach the deductible for Part B, you’ll pay 20% of the Medicare-approved cost of the medical care you receive. There is no out-of-pocket maximum. For prescription drugs, after the deductible, there are specific copayments each time you need medication.

While Medicare Advantage may also have a monthly premium, there are many plans with $0 premiums. Therefore, many plans won’t cost any more than you already pay for Medicare Part B, and they already include prescription drugs.

Each Medicare Advantage plan has its own out-of-pocket costs, including deductibles, copayments, and coinsurance. You’ll want to compare plans before making your final decision. Most Medicare Advantage plans also have an out-of-pocket cost maximum each year, after which the plan covers 100%.

Can You Switch From Medicare Advantage to Original Medicare?

You can switch from Medicare Advantage and Original Medicare in two different enrollment periods each year. The first is Open Enrollment, which is between October 15th and December 7th each year. You can make any changes to your Medicare plan that you like during this timeframe.

The second time you can switch plans is during the Medicare Advantage Annual Enrollment Period, which is between January 1st and March 31st each year. If you have a Medicare Advantage plan during this time, you can choose a different Medicare Advantage plan or switch from Medicare Advantage to Original Medicare.

Some circumstances create a special enrollment period, where you can make changes to your Medicare coverage outside of the normal windows. For instance, if you move out of your Medicare Advantage coverage area, you have an opportunity to choose a new plan or switch to Original Medicare.

Learn More About Original Medicare vs. Medicare Advantage

Understanding the differences between Medicare Advantage and Original Medicare is essential to making the right decision for your needs. However, it often helps to talk to a licensed insurance agent as well. If you have questions about your Medicare coverage and want to compare plans, contact us today!

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