Comparing Original Medicare vs Medicare Advantage
Most older adults and those with certain disabilities enroll in Original Medicare, which includes Part A (hospital insurance) and Part B (medical insurance). Original Medicare lets you visit any doctor or hospital in the U.S. that accepts Medicare but often comes with high out-of-pocket costs and may not cover medications.
To manage these costs, many people add supplements to Original Medicare or opt for Medicare Advantage (Part C), which replaces Parts A and B, offering similar services but functioning like independent health insurance.
What is Original Medicare?
Original Medicare consists of Part A and Part B.
Medicare Part A covers:
- Hospital stays and care
- Skilled nursing facilities (subject to criteria)
- Hospice care
- Home health care not related to hospice
Medicare Part B covers:
- Doctor visits and preventive care
- Medical equipment
- Lab tests
- Same-day surgery
- Counseling and therapy sessions
- Ambulance services
However, Parts A and B don’t cover eye exams for glasses, most dental care, dentures, cosmetic surgery, acupuncture, hearing aids, or outpatient prescription drugs.
What is Medicare Advantage (Part C)?
Medicare Advantage plans, sold by independent insurers, replace Part A and Part B but include all their services and often additional benefits like vision, hearing, and dental coverage. They may also include prescription drug coverage.
Costs and Coverage
Original Medicare can be costly without supplemental coverage. Medicare Advantage plans have an annual out-of-pocket maximum of $8,850, capping costs for covered services.
Types of Medicare Advantage plans:
- Health Maintenance Organizations (HMOs): Require choosing a primary care doctor and referrals for specialists.
- Preferred Provider Organizations (PPOs): Allow seeing any Medicare-accepting provider but offer lower costs for in-network services without needing referrals.
Comparing Original Medicare vs Medicare Advantage
- Providers: Original Medicare allows seeing any Medicare-accepting doctor or hospital in the U.S., while Medicare Advantage may restrict you to a network.
- Service Area: Original Medicare is limited to the U.S. Medicare Advantage networks can be restrictive if you live in multiple locations.
- Cost: Original Medicare has no cap on out-of-pocket expenses, while Medicare Advantage caps them at $8,850 annually.
- Referrals: Original Medicare doesn’t require referrals for specialists; some Medicare Advantage plans do.
- Benefits: Medicare Advantage may offer additional benefits not covered by Original Medicare, like dental and vision.
- Prescription Drugs: Original Medicare doesn’t cover outpatient prescription drugs without a Part D supplement. Many Medicare Advantage plans include drug coverage.
Conclusion
Weighing the pros and cons of Original Medicare vs Medicare Advantage is essential for making the best decision for your healthcare needs and financial situation. Remember, you can switch plans during open enrollment periods.
Article Sources
- Centers for Medicare & Medicaid Services. “Get Started with Medicare.” Medicare.gov, https://www.medicare.gov/basics/get-started-with-medicare. Accessed 18 June 2024.
- Centers for Medicare & Medicaid Services. “Home Health Services.” Medicare.gov, https://www.medicare.gov/coverage/home-health-services. Accessed 18 June 2024.
- Social Security Administration. “Medicare.” SSA.gov, https://www.ssa.gov/pubs/EN-05-10043.pdf. Accessed 18 June 2024.
- Centers for Medicare & Medicaid Services. “Hospice Care.” Medicare.gov, https://www.medicare.gov/coverage/hospice-care. Accessed 18 June 2024.
