What Are the Pros and Cons of Medicare Advantage vs Original Medicare?
In some ways, Medicare Advantage is very similar to Original Medicare. Both give you basically the same set of Medicare Part A and Part B benefits. Hospice benefits come directly from Part A even if you have a Medicare Advantage plan.
Since Original Medicare (Part A and Part B) and Medicare Advantage give you mainly the same set of benefits, why would you choose one way of getting coverage over the other? We’ll set out the pros and cons of Medicare Advantage vs. Original Medicare.
Medicare Advantage: A Quick Overview
The Medicare Advantage (Medicare Part C) program gives you another way to get your Medicare Part A and Part B coverage. Private insurance companies approved by Medicare offer Medicare Advantage plans.
Most Medicare Advantage plans include prescription drug coverage. Some plans offer more benefits, like routine dental or hearing care.
You need to have Medicare Part A and Part B to be eligible for Medicare Advantage. You have to live in the plan’s service area, and in most cases, you can’t have end-stage renal disease (a type of kidney failure). And one more thing: you must still pay your Medicare Part B premium, along with the plan premium if it charges one.
Original Medicare: A Quick Overview
The government health insurance program created in 1965 is called Original Medicare. It’s made up of:
- Part A, which is hospital insurance and generally covers care at skilled nursing facilities and sometimes nursing homes
- Part B, which is medical insurance and generally covers preventive care, doctor visits, lab tests, durable medical equipment, and more.
Part A and Part B come with deductible amounts, coinsurance, and/or copayments for most services.
If you’re automatically enrolled in Medicare, as many people are, you’re usually enrolled in Part A and Part B. If you’re already getting Social Security benefits when you turn 65 or qualify by disability, you’re usually enrolled automatically.
Medicare Advantage vs. Original Medicare
|Medicare Advantage||Original Medicare|
|Medicare Part A and Part B covered services||Yes||Yes|
|Prescription drug coverage||Yes, with most plans (not all)||Includes limited prescription drug coverage in certain situations. Doesn’t typically cover prescriptions you take at home.|
|Your choice of any doctor who takes Medicare assignment||It depends on the plan. Some Medicare Advantage plans require you to use doctors in the plan’s network.||Yes|
|Extra benefits, like routine vision or dental services, routine hearing services, membership in fitness programs, and more.||Yes, with many plans. The extra benefits (if any) may vary from one plan to another.||No|
|Covered services when you travel anywhere in the USA||Usually, no. You must live within your plan’s service area, except in emergencies.||Yes|
|Deductibles||Some plans may have deductibles.||Yes|
|Coinsurance or copayments||Generally, yes, for most services||Generally, yes, for most services|
|Premiums||It depends on the plan. Some plans have premiums as low as $0.
You still need to pay the Medicare Part B monthly premium as well.
|Medicare Part A has a monthly premium, but most people don’t have to pay it.*
Most people pay a Medicare Part B monthly premium.
|Annual maximum out-of-pocket spending limit. If you reach this limit, the plan may pay your medical expenses for the rest of the year.||Yes. This amount will vary among plans and might change year to year.||No|
* If you’ve worked at least 10 years (40 quarters) while paying Medicare taxes, you generally don’t pay a premium for Medicare Part A.
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