Whether you are approaching Medicare or already have Medicare, you might be wondering what is the difference between “Original Medicare,” and “Medicare Advantage Plans”?
To begin, think of Original Medicare (parts A & B) as a-la-carte, you decide if you want Part D (drug), and a Supplemental Plan (gap coverage). Part A (inpatient & skilled nursing) is free. Part D and supplemental plans have separate monthly premiums provided through private insurance companies.
With Original Medicare, you can choose any provider who accepts Medicare, and no referrals are required, no matter where you are in the US. Supplemental plans are designed to cover out-of-pocket costs.
Medicare Advantage plans are a pre-fixed meal, which includes all parts (A, B, and D), for one monthly premium. Advantage plans are approved by Medicare and managed by private insurance companies and can be more restrictive than Original Medicare. Plans are either HMO or PPO. You choose a network primary care provider, and in most cases, you will need a referral to see a specialist. Advantage plans have an annual cap on maximum out-of-pocket expenses and cover the same hospital and medical services that Original Medicare covers, and then more. Advantage plans can provide dental, vision, hearing coverage, plus gym memberships and over-the-counter products for free.
Making your Medicare choice is not a one-size-fits-all. Before deciding, evaluate where you live – access to provides and medical facilities, current and potential healthcare needs, and financial resources.