Original Medicare or Medicare Advantage: Which option is right for you?

Deciding between Original Medicare and Medicare Advantage is an important choice when you become eligible for Medicare. Original Medicare includes Part A (hospital stays) and Part B (doctor visits). With Original Medicare, you can go to any doctor or hospital that accepts Medicare, but it does not cover everything. For example, it doesn’t include prescription drug coverage. For that, you will need to enroll in a separate Part D plan.

Medicare Advantage (Part C) covers everything that Original Medicare covers, plus extra benefits like dental, vision, and hearing. It also often includes prescription drug coverage. With Medicare Advantage plans, you may have to use a network of doctors and hospitals covered by the plan or pay higher cost for out-of-network.

Choosing between these two options is important because it affects how you get your medical care and how much you might pay out-of-pocket. Knowing the difference between the two will help you choose a plan that is right for your needs and budget.

What is Original Medicare?

Medicare is a federal insurance program for people 65 and older or those with disabilities or end-stage renal disease. The two main parts are:

Medicare Part A: Covers inpatient hospital stays, stays in a skilled nursing facility, hospice care, and some home health care. Most people do not pay a premium for Part A if they or their spouse paid Medicare taxes while working. 

Medicare Part B: Covers doctor’s office visits, outpatient care, medical supplies, and preventive services. Most people pay a monthly premium for Part B. There is also a deductible. After the deductible is met, Medicare pays 80 percent for covered services. 

Original Medicare does not cover everything. It does not include routine dental, vision, or hearing, and it does not cover prescription drugs. Members often need to purchase additional coverage, like a Medicare Part D drug plan or Medicare Supplement Insurance (Medigap) to help with out-of-pocket costs for deductibles, copays, and coinsurance. 

What is Medicare Advantage?

Medicare Advantage is Medicare coverage offered by private insurance companies. It combines your Part A (hospital), Part B (doctor), and sometimes Part D (prescription drugs) coverage into one plan. It also includes other benefits not covered by Original Medicare like dental, vision, hearing, fitness programs, and an allowance for over-the-counter (OTC) products. 

Members still pay the Part B premium and may have additional premiums, copays, and coinsurance. However, Medicare Advantage plans still may offer lower out-of-pocket costs from Original Medicare. Medicare Advantage plans often have a maximum out-of-pocket to limit yearly spending for covered services. 

Differences between Medicare Advantage and Original Medicare plans

Is Medicare Advantage better than Original Medicare?

Your health care decision is important because it affects where you can get care and how much you may pay. Ultimately, the decision between Original Medicare or Medicare Advantage will come down to each person and their unique needs.
Here are some benefits offered by Medicare Advantage plans that are not covered by Original Medicare:

• Vision care, including eye exams and glasses
• Dental care, including cleanings and dentures
• Hearing care, including hearing aids
• Prescription drugs (Part D)
• An allowance for OTC drugs
• Wellness programs and gym memberships

Learn more about Medicare