We have created a comprehensive guide to help you understand the differences between Original Medicare and Medicare Advantage plans, and to help you decide which option is the best fit for your needs. In this article, we’ll provide detailed information on the benefits and drawbacks of each plan, as well as an overview of the coverage options available.

What is Original Medicare?

Original Medicare is the traditional health insurance program offered by the federal government to eligible individuals who are 65 years or older, as well as those who have certain disabilities or end-stage renal disease. Original Medicare consists of two parts: Medicare Part A (hospital insurance) and Medicare Part B (medical insurance).

Medicare Part A

Medicare Part A covers inpatient hospital care, skilled nursing facility care, hospice care, and home health care. You generally don’t have to pay a premium for Part A coverage if you or your spouse paid Medicare taxes while working.

Medicare Part B

Medicare Part B covers medically necessary services and preventive care, such as doctor visits, outpatient care, and some medical equipment. You’ll typically pay a monthly premium for Part B coverage, and you may also have to pay deductibles and coinsurance.

What is Medicare Advantage?

Medicare Advantage (also known as Medicare Part C) is an alternative to Original Medicare offered by private insurance companies. Medicare Advantage plans must offer the same coverage as Original Medicare, but they often include additional benefits, such as prescription drug coverage, dental, vision, and hearing coverage.

Types of Medicare Advantage Plans

There are four main types of Medicare Advantage plans:

1. Health Maintenance Organization (HMO) plans
2. Preferred Provider Organization (PPO) plans
3. Private Fee-for-Service (PFFS) plans
4. Special Needs Plans (SNP)

Choosing Between Original Medicare and Medicare Advantage

When choosing between Original Medicare and Medicare Advantage, it’s important to consider your individual needs and preferences. Here are some key factors to keep in mind:

Cost

Beneficiaries must first enroll in Original Medicare (Part A and Part B) before they can choose to enroll in a Medicare Advantage plan. While the costs of Original Medicare and Medicare Advantage plans can vary depending on a variety of factors such as income, location, and specific plan features, it is true that beneficiaries generally cannot enroll in a Medicare Advantage plan without first enrolling in Original Medicare.

Coverage

Original Medicare covers a wide range of healthcare services, but it may not cover all of the services you need. Medicare Advantage plans may offer additional benefits that aren’t covered by Original Medicare, such as vision, dental, and hearing care. However, Medicare Advantage plans typically have more restrictions on which healthcare providers you can see.

Provider Choice

With Original Medicare, you can choose any healthcare provider who accepts Medicare. With Medicare Advantage, you may be restricted to a network of providers or required to get a referral to see a specialist.

Making a Decision

Choosing between Original Medicare and Medicare Advantage can be a difficult decision. We recommend that you do your research, consider your individual needs and preferences, and speak with a licensed insurance agent to help you make an informed decision.

In conclusion, both Original Medicare and Medicare Advantage have their advantages and disadvantages. Original Medicare offers greater flexibility in provider choice, while Medicare Advantage plans may offer additional benefits that can save you money. Ultimately, the choice between the two plans will depend on your individual healthcare needs and budget. We hope this guide has provided you with the information you need to make an informed decision. If you have additional questions, reach out to the Plan Medicare team and we can help with all of your Medicare needs.