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 deciding between Original Medicare and Medicare Advantage, understanding the key differences in coverage, costs, and provider flexibility is crucial. Original Medicare provides basic hospital and medical insurance (Part A and Part B) but requires additional plans for prescription drugs and supplemental coverage. On the other hand, Medicare Advantage combines your coverage into one plan, often including prescription drugs and offering extra benefits like vision and dental. Each option has its own set of rules, networks, and costs, so knowing the ins and outs can help you choose the right path for your healthcare needs.
Click here to download a printable comparison chart.
Original Medicare vs. Medicare Advantage Comparison
Coverage
- Original Medicare
- Basic Coverage: Includes Part A (hospital) and Part B (medical)
- Prescription Drugs: Requires separate Part D plan
- Extra Benefits: Does not cover vision, dental, hearing
- Medicare Advantage
- Basic Coverage: Bundles Part A and Part B, usually includes Part D (prescription drugs)
- Prescription Drugs: Often included
- Extra Benefits: May offer additional benefits like vision, dental, hearing
Costs
- Original Medicare
- Deductible: Part B premium ($174.70 in 2024) plus optional Part D premium
- Co-payment (Co-pay):
- Part A: $1,632 for inpatient hospital (2024)
- Part B: $240 (2024)
- Out-of-pocket Limit: No yearly limit unless you have supplemental coverage
- Coinsurance: Typically 20% for Part B services
- Medicare Advantage
- Deductible: Part B premium plus possible additional plan premium (some plans have $0 premium)
- Co-payment (Co-pay): Varies by plan
- Out-of-pocket Limit: Yearly limit on out-of-pocket costs
- Coinsurance: Varies by plan and service
Provider Network
- Original Medicare
- Doctor Choice: Any doctor or hospital that accepts Medicare nationwide; most cases you don’t need a referral for specialists
- Out-of-network Coverage: Covered anywhere in the U.S.
- Medicare Advantage
- Doctor Choice: Often limited to plan's network; may need referrals for specialists
- Out-of-network Coverage: May have higher costs or no coverage for out-of-network care
Flexibility and Administration
- Original Medicare
- Plan Administration: Federal Government
- Changing Plans: Can switch during the Medicare Open Enrollment Period
- Supplemental Coverage: Can purchase Medigap policies
- Medicare Advantage
- Plan Administration: Private Insurance Companies
- Changing Plans: Can switch during the Medicare Open Enrollment Period
- Supplemental Coverage: Cannot purchase Medigap policies
Foreign Travel
- Original Medicare
- Travel Coverage: Limited coverage outside the U.S.; you may be able to purchase Medigap for emergency coverage
- Medicare Advantage
- Travel Coverage: Generally no coverage outside the U.S.; some plans may offer emergency coverage
Approval for Services
- Original Medicare
- Prior Authorization: Generally not required
- Medicare Advantage
- Prior Authorization: May need plan approval for certain services or supplies
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.