How Are Original Medicare And Medicare Advantage Different?

August 30, 2021
Original Medicare and Medicare Advantage plans

Original Medicare differs from Medicare Advantage in its coverage options, costs, provider options, enrollment, and eligibility for Medicare Supplements.

Learn more about your Medicare plan choices by contacting Healthcare Solutions Direct.

Medicare Advantage Extra Benefits

Original Medicare and Medicare Advantage have the same Part A and Part B coverage. But Medicare Advantage plans can offer their members other benefits.

Original Medicare does not have coverage for routine dental, vision, or hearing care. Medicare Advantage plans can fill this gap in coverage by offering dental, vision, or hearing insurance packages along with their normal coverage. Members can easily add these plans to their benefits for an additional monthly premium.

Medicare Advantage Prescription Drug (MAPD) plans have the coverage of Medicare Part A, Part B and Part D all in one. The prescription drug coverage of these Medicare Advantage plans is equivalent to the coverage offered under standalone Medicare Part D prescription drug plans.

Out-of-Pocket Costs

When you are enrolled in a Medicare Advantage plan, you show your plan card instead of your Medicare card. This is because your healthcare provider needs to bill the Medicare Advantage plan instead of Medicare for your healthcare expenses. 

Original Medicare and Medicare Advantage plans can both be expected to charge monthly premiums along with deductibles and copayments or coinsurance. Medicare Part A under Original Medicare charges the $1,484 deductible for each benefit period. Your Medicare Advantage plan will not necessarily use benefit periods or charge you the same amount for the same covered services. You should have yearly deductibles under a Medicare Advantage plan. Costs between Medicare Advantage plans vary.

Provider Networks

With Original Medicare, you can see any healthcare provider who accepts Medicare. If you have a Medicare Advantage plan, you may be more limited in your provider choices.

Medicare Advantage plans usually work with networks of healthcare providers whom the plan has negotiated with for lower rates for their members. These networks are confined to a specific region in the plan’s coverage area. You may have to pay more to see a provider outside of the plan’s network.

Enrolling in Original Medicare and Medicare Advantage

You will first enroll in Medicare Part A and Part B (Original Medicare) when you sign up for Medicare benefits. Then you can choose to sign up for a Medicare Advantage plan if you live within the plan’s coverage area. 

Medicare Advantage plans are yearly contracts, meaning you have to review your coverage each fall and can compare prices to decide if you want to switch plans. You can switch to a different Medicare Advantage plan or drop your plan and return to Original Medicare during the Open Enrollment period from October 15 to December 7.

Eligibility for Medicare Advantage

You can only be enrolled in either a Medicare Advantage plan or Medicare Supplement plan. That means you must choose between the two cost-savings options. If you have Original Medicare, you can add a Medicare Supplement or Medicare Advantage plan.

Within the first 12 months of joining your first Medicare Advantage plan or Medicare Supplement plan, you can decide the plan is not a good fit for you and switch to the opposite plan (from a Medicare Advantage plan to a Medicare Supplement, or vice versa).

Call Healthcare Solutions Direct

We are here to help you understand all your Medicare options. To learn more about Original Medicare, Medicare Advantage, and other parts of Medicare, give us a call today.

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