Medicare Advantage Plans vs. Original Medicare The Original Medicare plan is not free of charge. Although the cost of Part A is usually covered, most people pay a premium for Part B. You will pay a 20% coinsurance as well as copayments and deductibles. However, insurance can be added to supplement costs and coverage. Original Medicare Coverage Original Medicare plans cover tests, services and items that are considered medically necessary or needed to diagnose and treat your medical condition. They also cover services to prevent illness or detect a condition at an early, more treatable stage.
What is Medicare Advantage?
If you want more comprehensive coverage bundled into one plan, Medicare Advantage may be the answer. Medicare Advantage, or Medicare Part C, offers the same coverage as Original Medicare, along with additional services. Coinsurance rates also may be lower, but your provider network is often limited to a specific area. Medicare Advantage is available through private insurance companies, so coverage varies depending on your policy. Often additional coverage is available for:
Prescription drugsRoutine vision careHearing servicesDental careMembership in fitness programs
Medicare Advantage Plans
Not all Medicare Advantage plans are the same. Costs and coverage vary depending on the plan and the private insurance company. The most common Medicare Advantage plans include:
Health Maintenance Organization (HMO) Plans – Generally you must get your care from providers in your network, except for emergency or urgent care. In most cases, you need to choose a primary care doctor and will need a referral for most specialty services.Preferred Provider Organization (PPO) Plans – In most cases, you can get health care from any provider, but services will cost more if they are not in the plan’s preferred network. You will not need to choose a primary care provider or get a referral for services.Private Fee-for-Service (PFFS) Plans –These plans determine how much you pay vs. your plan for each service you receive. You do not need to choose a primary care doctor or get referrals. Out-of-pocket costs are lower for providers that are in the plan’s network.Special Needs Plans (SNPs) – Membership in these plans is limited to those with specific conditions or characteristics. Benefits and network providers are tailored to meet the needs of that group, and you typically must stay in network to receive care.
Pros and Cons of Medicare Advantage Plans vs. Original Medicare
For the most part, Original Medicare and Medicare Advantage offer the same basic benefits (Medicare Part A and Part B). The differences come in the specific cost details and what options work best for your healthcare needs and lifestyle choices.
Original Medicare vs. Medicare Advantage
*Out-of-pocket costs can be supplemented with a Medigap plan. **You have the option to add prescription drug coverage with a Medicare Part D plan.
Compare Medicare Plans: Original Medicare or Medicare Advantage?
There is an overwhelming amount of information online about Medicare, both good and bad. It’s important to ensure the information you receive is accurate and reliable, so you can make informed decisions about your health insurance. If you are evaluating a Medicare Advantage, Medigap and/or a Medicare Part D plan, consider speaking to a professional who can match you with the top insurance carriers in your area that meet your healthcare needs. Each Medicare plan and insurance product we feature has been independently selected and reviewed by the Medicare Expert USA team. If you make a purchase using the links included, Parade.com may be compensated. Next up, here’show to be a good caregiver and take good care of yourself, too.
