Original Medicare and Medicare Advantage plans have significant differences across various aspects, including cost, out-of-pocket maximum, provider network, drug coverage, additional benefits, and more. The table below provides a summary of the major distinctions between the two:
| Original Medicare | Versus | Medicare Advantage |
|---|---|---|
| Original Medicare provides coverage for hospital services (Part A) and medical services (Part B). It includes inpatient hospital stays, doctor visits, preventive care, and some medical equipment. However, it does not cover prescription drugs, dental, vision, or hearing care. | Coverage | Medicare Advantage plans provide all the coverage of Original Medicare (Part A and Part B) and often include additional benefits such as prescription drug coverage (Part D), dental, vision, hearing, and wellness programs. Medicare Advantage plans are offered by private insurance companies approved by Medicare. |
| With Original Medicare, you generally pay a monthly premium for Part B and Part A (if applicable) | Premium Cost | Medicare Advantage plans usually have a monthly premium in addition to the Part B premium and Part A (if applicable). Some Medicare Advantage plans have a $0 premium |
| Part A and Part B deductibles, coinsurance, and copayments for services | Out-of-Pocket Cost | You are required to utilize healthcare providers within your local and regional network. In the case of a PPO, you have the option to seek services outside of the network, but it may result in additional costs or fees |
| No limit | Maximum-Out-of-Pocket (MOOP) | The out-of-pocket costs, such as deductibles, copayments, and coinsurance, vary depending on the specific plan |
| You can visit any healthcare provider that accepts Medicare patients. There are no network restrictions, giving you a wide choice of doctors, hospitals, and specialists nationwide | Provider Network | Medicare Advantage plans have a network of healthcare providers. You typically need to use doctors and hospitals within the plan's network, although emergency care is covered anywhere in the United States |
| Under Original Medicare, you have the freedom to see any specialist or receive medical services without referrals | Coordination of Care | Medicare Advantage plans often require you to choose a primary care doctor and obtain referrals to see specialists. This can help coordinate your healthcare and manage your overall care |
| Original Medicare does not include prescription drug coverage. To obtain prescription drug coverage, you can enroll in a separate Medicare Part D plan | Prescription Drug Coverage | Most Medicare Advantage plans include prescription drug coverage (Part D) as part of their benefits package |
| Original Medicare does not cover additional benefits like dental, vision, or hearing care | Additional Benefits | Medicare Advantage plans often offer additional benefits such as dental, vision, hearing, fitness programs, and wellness services |
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