Written by: Vanessa Jerusalimiec (*Amsive Digital) | Reviewed by: Shelley Wyant | *MHP partners with Amsive Digital on news content
Original Medicare vs. Medicare Advantage
Choosing between Original Medicare vs Medicare Advantage can be a big decision. As you weigh your options, you’ll need to consider coverage and costs.
Original Medicare Coverage
Original Medicare is the federal health insurance program for older adults over 65. It is divided into Part A and Part B, each with unique coverage options.
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Medicare Part A covers hospital visits, nursing home care, skilled nursing facility care, and home health care.
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Medicare Part B covers medical services such as doctor’s visits, ambulance services, preventative services, and durable medical equipment.
You can enroll in just Medicare Part A, but most older adults choose to enroll in both Medicare Part A and Part B.
Medicare Advantage Coverage
Medicare Advantage plans, also called Medicare Part C plans, are offered by private insurance companies. These comprehensive plans provide more coverage than Original Medicare. Each private insurance company offers plans that may vary from state to state and even county to county within their service area.
Medicare Advantage plan coverage can include:
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All the same services covered in Medicare Parts A and B.
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Additional services like vision, dental, and hearing coverage.
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Transportation services to health appointments.
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Prescription drug coverage.
Are You Eligible for Medicare?
Original Medicare and Medicare Advantage have the same eligibility requirements. You’re eligible for Medicare if:
Original Medicare vs Medicare Advantage: Cost
A big factor in deciding what healthcare plan to choose is the cost. Here’s how much traditional Medicare vs Medicare Advantage costs.
Original Medicare Costs
Most older adults qualify for premium-free Part A. If you paid Medicare taxes while working, you likely won’t need to pay Part A premiums. Medicare Part B has a monthly premium starting at $174.70 in 2024.
Both Medicare Part A and Part B also have yearly deductibles. You’ll need to pay this amount before coverage kicks in. For 2024, the Part A deductible is $1,556, and the Part B deductible is $233. After you’ve met your yearly deductible, Original Medicare will pay 80% of the Medicare-approved amount, and you’ll pay the remaining 20%.
Medicare Advantage Costs
Each Medicare Advantage plan can set their own costs. Monthly premiums vary by plan. Some insurance agencies offer Advantage plans with premiums as low as $0. Deductibles and copayments also vary by plan. For example, you may need to pay a copayment of $10 or $20 when you visit your doctor.
Pros and Cons of Medicare Advantage Plans vs Original Medicare
Coverage:
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Original Medicare:
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Medicare Advantage:
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Original Medicare covers medically necessary hospital and medical services. It does not cover additional benefits.
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Medicare Advantage plans cover the same services as Original Medicare along with extra benefits such as dental, vision, and hearing services.
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If you need drug coverage, you can enroll in a Medicare Part D plan.
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Prescription drug coverage is included in most Medicare Advantage plans.
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Cost:
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Original Medicare:
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Medicare Advantage:
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Medicare Part B monthly premiums start at $174.70. If you enroll in a Part D plan, you’ll pay an additional monthly premium.
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When you enroll in a Medicare Advantage plan, you may have to pay the Part B premium as well as the Advantage plan premium. Some plans have premiums starting at $0.
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When you access healthcare, you’ll pay a coinsurance of 20%. Original Medicare will pay for 80% of the Medicare-approved amount, and you’ll pay the rest.
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Medicare Advantage plans usually have copayments. You’ll pay a fixed price every time you see your doctor or access care. Each plan sets their own costs.
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You’ll pay the coinsurance the whole year, no matter how much you’ve paid out-of-pocket during the year.
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Medicare Advantage Plans have a yearly out-of-pocket limit. Once you reach the limit, you won’t pay any copayments when you access medically necessary services.
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Accessing Care:
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Original Medicare:
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Medicare Advantage:
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When you’re enrolled in Original Medicare, you can visit any doctor or hospital that accepts Medicare coverage.
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If you have a Medicare Advantage plan, you will need to visit healthcare providers that are in your plan’s network. If you access out-of-network care, you may have higher copayments or services may be denied.
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Choosing the Right Plan for Your Needs
When you’re choosing a Medicare plan, you’ll want to consider cost and coverage. You’ll also need to carefully consider your healthcare needs. If you only visit the doctor and rarely have other healthcare costs, Original Medicare may be a perfect choice. But if you have additional healthcare needs, access dental, vision, and hearing services, or have other health concerns, a Medicare Advantage plan may be a better option.