Jane Dotson
There are two main ways to get Medicare coverage: Original Medicare and Medicare Advantage. Original Medicare is government health insurance for people aged 65 and older or those living with certain disabilities. It includes Part A (hospital insurance) and Part B (medical insurance). Medicare Advantage, also called Medicare Part C, is a bundled alternative sold by private insurers. It covers the same benefits as Medicare Part A and Part B but may also include Part D (prescription drug coverage) and additional benefits like dental and vision coverage. Medicare Advantage plans may be a better option for those who cannot afford a Medigap plan, but they come with provider networks and prior authorization.
| Characteristics | Values |
|---|---|
| Type | Traditional Insurance is government health insurance. |
| Medicare Advantage is a bundled alternative sold by private insurers. | |
| Coverage | Traditional Insurance includes Part A (hospital insurance) and Part B (medical insurance). |
| Medicare Advantage includes Part A, Part B, and Part D (prescription drug plan) all in one plan. | |
| Cost | Traditional Insurance has notable gaps in coverage, requiring cost sharing for most services. |
| Medicare Advantage may have zero-dollar premiums, reduced cost sharing, and an out-of-pocket spending limit. | |
| Provider Choice | Traditional Insurance lets you see any provider that accepts Medicare. |
| Medicare Advantage restricts you to the plan's network of doctors and hospitals. | |
| Supplemental Coverage | Traditional Insurance does not cover eyeglasses, hearing aids, basic dental care, or long-term care. |
| Medicare Advantage may cover additional services such as eyeglasses, dental, fitness club memberships, caregiver support, meal delivery, or acupuncture. | |
| Enrollment | Traditional Insurance has been the primary option for Medicare since the 1970s. |
| Medicare Advantage plans have gained popularity, with 54% of eligible beneficiaries enrolled in 2024. |
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What You'll Learn
- Medicare Advantage is an alternative to traditional Medicare, offered by private insurers
- Original Medicare lets you see any provider that accepts Medicare
- Medicare Advantage may be cheaper, but it has provider networks and prior authorization
- Medicare Advantage may cover more, but it restricts more
- Original Medicare has notable gaps in coverage
Medicare Advantage is an alternative to traditional Medicare, offered by private insurers
Medicare Advantage, also known as Medicare Part C, is an alternative to Original Medicare. It is offered by private health insurance companies and combines Medicare Part A and Part B.
Original Medicare is government health insurance for people aged 65 and over, or those living with certain disabilities. It includes Part A (hospital insurance) and Part B (medical insurance). Once you have signed up for these, you can choose how you get your health coverage. With Original Medicare, you can see any doctor or hospital that accepts Medicare anywhere in the US.
Medicare Advantage is a bundled alternative, with different copayments and deductibles to Original Medicare. It may be a better option for those who cannot afford a Medigap plan. Medicare Advantage plans have provider networks and costs for getting medical care, such as deductibles, copays, and coinsurance. These costs can be low if you are healthy, but they can add up if you have a serious condition.
Medicare Advantage plans have become increasingly popular. In 2024, 54% of eligible beneficiaries were enrolled in a Medicare Advantage plan. The average enrollee has 43 plans to choose from. These plans may have zero-dollar premiums, extra benefits, and an out-of-pocket spending limit. However, they also come with provider networks and prior authorization.
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Original Medicare lets you see any provider that accepts Medicare
Original Medicare is government health insurance for people aged 65 and over or those living with certain disabilities. It is made up of two parts: Part A (Hospital Insurance) and Part B (Medical Insurance). Part A covers inpatient hospital care, skilled nursing facility care, hospice care, and some home health care. Part B covers doctor's visits, preventive services, and durable medical equipment.
Medicare Advantage, also known as Part C, is an alternative to Original Medicare sold by private insurance companies. It combines Medicare Part A and Part B and often includes Medicare Part D prescription drug coverage and additional benefits like dental and vision coverage. Medicare Advantage plans have provider networks and may restrict your choice of doctors and hospitals. These plans may have lower premiums but may have higher costs for getting medical care, such as deductibles, copays, and coinsurance.
The choice between Original Medicare and Medicare Advantage depends on your individual needs and preferences. Original Medicare offers more flexibility in choosing your healthcare providers but may have higher out-of-pocket costs. Medicare Advantage provides an all-in-one plan with potentially lower premiums but may have limited provider networks and higher costs for certain services.
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Medicare Advantage may be cheaper, but it has provider networks and prior authorization
Medicare Advantage, also known as Medicare Part C, is an alternative to Original Medicare and is offered by private health insurers. It covers the same benefits as Medicare Part A (hospital insurance) and Part B (medical insurance). Medicare Advantage plans may be a cheaper option, with some plans offering zero-dollar premiums, reduced cost-sharing, and out-of-pocket spending limits. However, one of the trade-offs of choosing Medicare Advantage over Original Medicare is that it has provider networks and prior authorization.
Original Medicare allows users to see any doctor or hospital that accepts Medicare anywhere in the US. In contrast, Medicare Advantage plans have limited networks of doctors and hospitals, and users must typically use in-network providers to receive coverage for their care. This means that users may not be able to see their preferred specialists if they are out-of-network, which can be an issue if they have a serious health condition.
Medicare Advantage plans often require prior authorization for certain services, which means that users may need approval from the insurance company before receiving specific treatments or procedures. This can add an extra step and potential delay to the process of accessing medical care.
While Medicare Advantage plans may offer cost savings, it is important for users to carefully consider the provider networks and prior authorization requirements that may impact their access to preferred doctors and specialized care.
Additionally, it is worth noting that Medicare Advantage plans can change year to year, and users should review their coverage periodically to ensure it continues to meet their healthcare needs.
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Medicare Advantage may cover more, but it restricts more
Medicare Advantage, also known as Part C, is a bundled alternative to Original Medicare, sold by private insurers. It covers the same benefits as Medicare Part A and Part B, but may also include Part D prescription drug coverage and additional benefits like dental and vision coverage.
Original Medicare is government health insurance for people aged 65 and older or those living with certain disabilities. It includes Part A (hospital insurance) and Part B (medical insurance). You can add Part D (prescription drug plan) and/or Medicare Supplement Insurance (Medigap), but they are not included.
Original Medicare lets you see any provider that accepts Medicare, whereas Medicare Advantage has limited networks. You may only use doctors who are in the plan's network. If you have a serious health issue, you may not be able to see the specialists you prefer if they are out-of-network.
Additionally, while Medicare Advantage may have lower premiums, other costs differ from Original Medicare. For example, you will have different copayments and deductibles than with Original Medicare.
When deciding between Original Medicare and Medicare Advantage, it is important to consider your specific needs and circumstances, including your health history, the coverage options available in your area, and the potential costs associated with each plan.
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Original Medicare has notable gaps in coverage
Medigap policies are standardized, and in most states, they are named by letters, like Plan G or Plan K. The benefits in each lettered plan are the same, no matter which insurance company sells it. The price is the only difference between policies with the same letter sold by different companies. If you don't buy a Medigap policy within 6 months of when you first get Part A and Part B, you may not be able to buy a policy or you may pay more.
Original Medicare is government health insurance for people who are 65 or older or living with certain disabilities. It includes Part A (hospital insurance) and Part B (medical insurance). You can add a Part D (prescription drug plan) and/or Medicare Supplement Insurance (Medigap), but they are not included. Part A covers inpatient hospital care, skilled nursing facility care, hospice care, and some home health care. Part B covers doctor’s visits, preventive services, and durable medical equipment.
Medicare Advantage, also known as Part C, is a bundled alternative sold by private insurers. It covers the same benefits as Medicare Part A and Part B, and most plans also include Medicare Part D prescription drug coverage and additional benefits like some dental and vision coverage. Medicare Advantage plans have become increasingly popular, with nearly 33 million people enrolled in 2024. The average enrollee has 43 plans to choose from.
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Frequently asked questions
Original Medicare lets you see any provider that accepts Medicare, whereas Medicare Advantage may be a better option if you can’t afford a Medigap plan. Medicare Advantage plans are private health insurance plans paid by the federal government to provide Medicare-covered benefits as an alternative to “traditional” or “original” Medicare.
Medicare Advantage plans cost the government and taxpayers more than traditional Medicare per beneficiary. The government pays Medicare Advantage plans a set rate per person, per year under what’s known as a risk-based contract. Medicare Advantage plans have different copayments and deductibles than original Medicare.
Most Medicare Advantage plans include Part D coverage, whereas traditional Medicare does not have prescription drug coverage.
Original Medicare lets you use any doctor, whereas Medicare Advantage has limited networks.
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