Original Medicare vs. Medicare Advantage
Original Medicare is offered by the federal government and provides hospital and general medical expense coverage. Medicare Advantage is offered by private insurers and is an “all-in-one” alternative to Original Medicare that covers more services and costs.
Which is right for you? These are key differences between each plan to help you better compare options:
Most Medicare Advantage programs offer full prescription drug coverage, while Original Medicare only includes limited prescription drug coverage in certain situations. If prescription drug coverage is a priority for you, Medicare Advantage may be your best option.
Both plans allow you to choose any doctor who accepts your Medicare coverage. Some Medicare Advantage plans, however, have a specific network for you to seek coverage in, which lowers the overall cost of the plan. Medicare Advantage has multiple plans to choose from if you do not want to be limited to a network.
Medicare Advantage provides additional coverage such as dental, vision, and hearing care that Original Medicare alone does not.
Both Medicare Advantage and Original Medicare have deductibles and copayment/coinsurance fees. Both plans also require you to pay your Part A and B deductible (unless you are eligible for Premium-Free Part A).
Under Medicare Advantage, you will have an annual maximum out-of-pocket spending limit. This means that you will only be required to cover a limited amount of out-of-pocket costs—once you have paid to a certain point, your plan will pay for the rest. Original Medicare does not have this feature.
Who Offers The Coverage
Private Insurance Companies
What It Covers
Original Medicare includes Part A and Part B.
Inpatient care in hospitals and skilled nursing facilities
Hospice care and some home health care
Outpatient hospital services
Durable medical equipment
Some preventive health care
combines all of your coverage into one plan and often includes prescription drug coverage.
Plans can also offer
additional benefits Original Medicare doesn’t cover, like:
Vision, hearing and dental care
Disease management programs
24/7 access to health care professionals
What It Costs
Part A is free for most people.
The standard monthly premium for Medicare Part B enrollees is $170.10 in 2022, an increase of $21.60 from 2021.
Medicare also charges deductibles, copays and coinsurance.
Each Medicare Advantage plan sets
its own premium, in addition to your Part B premium.
Plans have predictable copays and coinsurance.
Annual cap on out-of-pocket expenses
Generally speaking, Part B covers about 80 percent of a person’s health care costs,
leaving them to cover the remaining 20 percent out of pocket.
Medicare Advantage plans set an out-of-pocket max to help you predict how much you may have to pay for health care services each year. The limit depends on the plan but can’t be more
than $8,700 in 2022.