To help you navigate these options and find the best plan for your needs, we’ve teamed up with Chapter to provide personalized, 1-1 guidance.
When it comes to selecting your Medicare coverage, one of the most significant decisions you'll make is whether to choose Original Medicare or a Medicare Advantage plan. This choice can feel overwhelming, but understanding the differences between these two options can help you make an informed decision that best suits your healthcare needs.
The Basics: What Are They?
Original Medicare consists of two parts: Part A (hospital insurance) and Part B (medical insurance). It’s the traditional program offered directly through the federal government. With Original Medicare, you can see any doctor or specialist who accepts Medicare, anywhere in the United States. You are also covered by Medicare-approved hospitals and healthcare providers. However, Original Medicare doesn’t cover everything; for instance, prescription drugs, dental, vision, and hearing are not included. Many people with Original Medicare choose to purchase a separate Medicare Part D plan for prescription drugs and may buy supplemental insurance, known as Medigap, to cover additional costs like copayments and deductibles. Learn more about your Medicare coverage options.
Medicare Advantage (also known as Part C) is an alternative to Original Medicare. These plans are offered by private insurance companies approved by Medicare. They cover everything Original Medicare does but usually include additional benefits, such as prescription drug coverage, dental, vision, and hearing services. Medicare Advantage plans often have networks of doctors and hospitals that you must use to get the lowest costs. These plans can vary widely in terms of coverage and costs, so it's important to compare your options carefully.
How Do They Differ?
- Provider Flexibility: With Original Medicare, you have the freedom to visit any healthcare provider that accepts Medicare, without worrying about network restrictions. Medicare Advantage plans, however, typically require you to stay within a specific network of doctors and hospitals. If you travel frequently or live in multiple locations throughout the year, Original Medicare might offer the flexibility you need.
- Costs: Original Medicare usually has higher out-of-pocket costs, especially if you don’t have supplemental insurance. You pay a monthly premium for Part B, and there are deductibles and coinsurance to consider. Medicare Advantage plans may offer lower premiums (sometimes even $0), but you might face higher copayments or coinsurance when you receive care. Additionally, while Medicare Advantage plans often include drug coverage, you may need to pay separate premiums for Part D if you stick with Original Medicare. Understand the costs associated with Medicare Advantage.
- Additional Benefits: One of the major advantages of Medicare Advantage plans is the extra coverage they provide. Many of these plans include dental, vision, hearing, and even wellness programs, which are not covered under Original Medicare. If these benefits are important to you, a Medicare Advantage plan might be the better choice. Explore the extra benefits of Medicare Advantage plans.
- Out-of-Pocket Limits: Original Medicare does not have a limit on how much you can spend out-of-pocket each year. This means that your healthcare costs could add up if you need a lot of care. In contrast, Medicare Advantage plans have an annual out-of-pocket maximum, which can offer peace of mind if you face high medical expenses. Learn more about out-of-pocket limits with Medicare Advantage.
To help you navigate these options and find the best plan for your needs, we’ve teamed up with Chapter to provide personalized, 1-1 guidance.
Making the Right Choice
Choosing between Original Medicare and Medicare Advantage depends on your individual healthcare needs, budget, and lifestyle. If you value flexibility and want to avoid network restrictions, Original Medicare with a Medigap policy might be the way to go. However, if you prefer an all-in-one plan that includes additional benefits and potentially lower upfront costs, a Medicare Advantage plan could be a better fit.
Take the time to assess your healthcare needs, consider the costs associated with each option, and think about what additional benefits are important to you. Remember, what works best for someone else might not be the best choice for you. Compare your Medicare coverage options here.
Understanding the differences between Original Medicare and Medicare Advantage is crucial for making the best decision for your health.
If you're still unsure about which option to choose, consider taking a Medicare class on GetSetUp. Our classes are designed to help you navigate these decisions with confidence.
Reviewed By: Keith Gilbert