Difference Between Original Medicare and Medicare Advantage Plans

Original Medicare vs. Medicare Advantage

When someone thinks about getting a Medicare healthcare insurance plan, the major decision is to choose an Original Medicare or choose a Medicare Advantage plan through a private insurer. If you select Original Medicare, you enroll for Part A, B, and D (hospital care, lab tests, doctor visits, labs, prescription drugs, and tests). However, if you choose Part C, a Medicare Advantage Plan (MA), it has everything Parts A, B, and D provide.

While some aspects are constant in both the plans, you must know some significant differences before opting for them.

Choosing a Provider

With Original Medicare, you have an option to choose a provider of your choice (who accepts Medicare). There is no need to have any referrals to visit medical providers. However, some Medicare Advantage Plans require you to see the healthcare providers who are in their network and obtain referrals to see specialists. You may also be expected to choose a primary care doctor.

Cost Coverage

Cost is undeniably one of the major factors that may impact your decision. Choosing Original Medicare means you will have to pay for standardized Part A and B costs that include a premium for Part B. If you visit a participating healthcare provider, you’re also responsible for 20 percent coinsurance for covered services.

With Medicare Advantage, the cost-sharing typically depends on the plan you choose. You usually have to pay for a copayment to receive in-network care. Some plans may charge people monthly premiums, which is an additional amount to the Part B premium you will still have to pay.

Covered Care

Note that there are some medical costs that Original Medicare doesn’t cover or doesn’t pay for, such as routine hearing, vision, dental care, and cosmetic surgery. Apart from these, Original Medicare can get you various healthcare services, including inpatient and outpatient services.

With Medicare Advantage, you receive all the medical services you’re eligible for with Original Medicare. Besides this coverage, some Medicare Advantage plans offer healthcare that original Medicare doesn’t cover, such as hearing, vision, and dental care. You may also get gym memberships in MA plans, as well as prescription drug coverage.

Supplement Insurance

Original Medicare allows you to join a Medicare Supplement Plan to help you pay costs not covered. Medicare Advantage doesn’t have this option.

Bottom Line

Overall, choosing between Original Medicare and Medicare Advantage is a big decision. You must carefully consider all the elements and features to choose an insurance plan that works best for you. Seeking advice from a professional is an ideal way to understand both the options. Contact Kannonball Insurance for all your Medicare-related questions.