Original Medicare vs Medicare Advantage

FESCH.TV INFORMIERT:

Not sure if you should keep Original Medicare or go with Medicare Advantage? Don’t go anywhere. We’re going to compare them side-by-side, so you can make the best choice for you.

While there are many similarities between Original Medicare and Medicare Advantage, they’re actually quite different. With Original Medicare, your benefits are administered by the federal government and include Part A and Part B. Part A is your hospital coverage and Part B is your medical coverage. You pay into both of these parts during your working career through Medicare taxes.

With Medicare Advantage, your benefits are managed through a private insurance company. Medicare pays the Medicare Advantage carrier to administer your benefits for both Part A and Part B. When Medicare Advantage is administering your benefits, it’s known as Part C. These private insurance companies must follow the guidelines that the federal government sets in place.

Now that we’ve gone over the basic difference between the two, let’s go over the pros and cons.

Original Medicare Pros:

• Benefits are identical from person to person
• There are no copays, no waiting periods, and no pre-existing condition limitations
• There are no networks, meaning you can see any doctor that accepts Medicare
• Any out-of-pocket costs will be the same regardless of the provider you choose
•Your coverage will also travel with you across the United States

Original Medicare Cons:

• Both Part A and Part B come with a deductible and coinsurance
• No maximum out-of-pocket
• No coverage for prescription drugs

Medicare Advantage Pros:
• Some areas have plans with $0 premiums
• Some plans have a Part B give-back option
• Plans have an out-of-pocket maximum limit
• Can come with additional perks like dental, vision, and hearing benefits, gym memberships, and long-term care
• Many plans include coverage for prescription medications

Medicare Advantage Cons:

• Benefits are different from plan to plan
• You still need to pay your Part B premium
• Limited doctor networks and need for a referral to see a specialist
• High cost per service
• Plans do not travel with you
• Maximum out-of-pocket limit could still break the bank

Now that we’ve discussed the pros and cons of both, let’s go over how doctor visits, covered services, and costs work.

Doctor Visits on Original Medicare:

• When you have Original Medicare, you can see any doctor or specialist that accepts Medicare without needing a referral
• Plans don’t change annually, so you don’t have to worry about your doctor leaving the plan’s network

Doctor Visits on Medicare Advantage:

• Most plans are HMOs or PPOs and you’ll have a primary care physician to direct all your care – therefore, you’ll need a referral to see a specialist
• Physicians can leave the plan’s network at any time

Covered Services on Original Medicare:

• A wide range of services are covered
• Does not include coverage for routine dental, vision, or hearing care

Covered Services on Medicare Advantage:

• Includes coverage for the same services Original Medicare covers plus possible coverage for dental, vision, and hearing

Costs on Original Medicare:

• Part A and Part B both come with a deductible and coinsurance
• You will pay a monthly premium for Part B
• No maximum out-of-pocket limit
• The Part A deductible is per benefit period

Costs on Medicare Advantage:

• You still need to pay your Part B premium in order to be eligible for a Medicare Advantage Plan

So, which is better –Original Medicare or Medicare Advantage? This answer depends on your specific situation and your health care coverage goals. If you’re looking to cover the gaps in Original Medicare, then the best option for you might be a Medigap plan in combination with a Part D prescription drug plan. If you can’t enroll in a Medigap plan, then having Medicare Advantage is better than just having Original Medicare.

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