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Medicare Advantage vs. Original Medicare. That’s a decision that around 10,000 people could face every day. The Centers for Medicare & Medicaid Services (CMS) reported in 2015 that about 10,000 people became eligible for Medicare each day.
Medicare Advantage vs. Original Medicare: what’s the difference?
Original Medicare, Part A and Part B, is the government health insurance program for those 65 and older, and for people who qualify by disability.
Some quick Medicare Part A facts:
Some quick Medicare Part B facts:
Original Medicare comes directly from the government. But you can choose to get your Part A and Part B benefits through the Medicare Advantage program instead.
The Medicare Advantage program (also called Medicare Part C) gives you a way to get these benefits through a private insurance company. These insurance companies contract with Medicare to deliver your Part A and Part B benefits.
Here’s a table to help you see – at a glance – the main differences between Original Medicare and Medicare Advantage.
|Medicare Advantage vs. Original Medicare|
|Benefit or feature||Medicare Advantage||Original Medicare|
|Medicare Part A and Part B benefits||Yes||Yes|
|Prescription drug coverage||Yes, with many plans (but not all)||Includes only limited prescription drug coverage. Original Medicare doesn’t cover most medications you take at home.|
|Additional benefits beyond Part A and Part B, such as routine vision or hearing care||Yes, with many plans (but not all). Extra benefits may vary among plans.||Generally, no|
|Choice of any doctor who accepts Medicare assignment||Not with every plan. Many plans require you to stay within the plan’s provider network.||Yes|
|Generally covers non-emergency care anywhere in the United States||Usually, no. You must live within the plan’s service area, although plans typically cover emergency care when you’re away from home in the U.S.||Generally, yes|
|Maximum out-of-pocket spending limit.||Yes. Once you’ve reached this limit within a calendar year, the plan may cover your medical costs for the rest of the year. This limit varies among plans and may change year to year.||No|
If you have a Medicare Advantage plan, you’re still in the Medicare program. You still need to pay your monthly Part B premium – plus the Medicare Advantage premium.
Medicare Advantage vs. Original Medicare: when do you have to choose?
There’s no hurry if you can’t make up your mind about Medicare Advantage vs. Original Medicare. In most cases, you’re automatically enrolled in Original Medicare as soon as you’re eligible, if you’re receiving Social Security benefits. If you want a Medicare Advantage plan, you have to take steps to sign up. And you can’t just sign up anytime – it’s important to be aware of your Medicare Advantage enrollment periods.
If you know from the get-go that you want a Medicare Advantage plan, you can sign up when you’re first eligible for Medicare. Your Medicare Initial Enrollment Period goes for 7 months for most people.
If you don’t enroll in Medicare Advantage during the Initial Enrollment Period, you may have other opportunities.
You can usually sign up for a Medicare Advantage plan if you’re enrolled in Medicare Part A and Part B, and live in the plan’s service area. If you have end-stage renal disease (permanent kidney failure), you might not qualify for most types of Medicare Advantage plans – call the plan you want to enroll in, and ask. You can generally enroll in a Special Needs Plan, which is a specific type of Medicare Advantage plan.
To enroll in a Medicare Advantage plan, you can contact the plan, or click Browse Plans on this page to display plans in your area. From there, you can enroll online.
Medicare Advantage vs. Original Medicare – do you still have questions? For personalized assistance, call eHealth to speak with a licensed insurance agent.
eHealth's Medicare website is operated by eHealthInsurance Services, Inc., a licensed health insurance agency doing business as eHealth. The purpose of this site is the solicitation of insurance. Contact may be made by an insurance agent/producer or insurance company. eHealth and Medicare supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. We offer plans from a number of insurance companies.