The Key Differences Between Original Medicare and Medicare Advantage

Sep 2023

When it comes to healthcare coverage for seniors in the United States, Medicare is the go-to program. However, there are two main options within Medicare: Original Medicare (Part A and Part B) and Medicare Advantage (Part C). Understanding the major differences between these two choices is essential for making an informed decision about your healthcare coverage.

  1. Coverage Structure
    • Original Medicare: Original Medicare consists of two parts – Part A (Hospital Insurance) and Part B (Medical Insurance). Part A primarily covers hospital care, while Part B covers doctor visits, outpatient services and preventive care.
    • Medicare Advantage: Medicare Advantage, also known as Part C, combines hospital (Part A) and medical (Part B) coverage into a single plan. In addition to these basic benefits, Part C plans often include prescription drug coverage and additional benefits like dental, vision and hearing.
  2. Provider Network
    • Original Medicare: With Original Medicare, you have the freedom to choose any healthcare provider or specialist that accepts Medicare, giving you a broad network of doctors and hospitals nationwide.
    • Medicare Advantage: Plan C plans typically have a network of healthcare providers, and you will be required to choose a primary care physician (PCP) within network. You may need referrals to see specialists within the network.
  3. Costs
    • Original Medicare: While Part A is often premium-free for those who have paid Medicare taxes, Part B requires a monthly premium. Additionally, you’ll face deductibles, coinsurance, and potentially substantial out-of-pocket expenses without supplemental insurance.
    • Medicare Advantage: Part C plans may have lower premiums than Original Medicare but often include co-pays and deductibles. The total out-of-pocket costs in Part C are typically capped, providing financial predictability.
  4. Prescription Drug Coverage
    • Original Medicare: If you select Original Medicare, you will need to pay for a separate drug plan (Part D).
    • Medicare Advantage: Most Part C plans include prescription drug coverage, making it a convenient option for those seeking comprehensive healthcare and drug benefits.
  5. Additional Benefits
    • Original Medicare: Original Medicare does not cover services like dental, vision, or hearing, leaving beneficiaries responsible for these expenses.
    • Medicare Advantage: Many Part C plans offer extra benefits, such as routine dental check-ups, eyeglasses, and hearing aids, which are not covered by Original Medicare.

The choice between Original Medicare and Medicare Advantage depends on your individual healthcare needs and financial situation. Original Medicare provides flexibility in choosing healthcare providers, while Medicare Advantage bundles various benefits under one plan. Carefully evaluating your options and considering your healthcare priorities will help you make the right choice for your Medicare coverage.

For more information, here are some helpful resources:


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