When joining Medicare, you have two choices for receiving coverage: Original Medicare or private Medicare Advantage plans.
Two major considerations for how to receive Medicare are your needs for specific health providers and additional benefits.
A licensed Medicare specialist can help you review your options and make an informed decision about your coverage.
When you’re joining Medicare, you have two options for receiving your healthcare coverage: through Original Medicare (Parts A and B) or through private Medicare Advantage (Part C) plans. Below is an overview of each plan to help you understand the main differences between the two.
What is Original Medicare?
Original Medicare (also called “Traditional Medicare”) refers to Medicare Parts A and B. It operates on a fee-for-service structure. This means that you can go to any healthcare provider or hospital in the U.S. that accepts Medicare. When Medicare-covered services are billed, Medicare pays a portion of the costs and you pay the rest out of pocket.
You might be wondering, “Does Medicare cover acupuncture?” or “Does Medicare cover cataract surgery?” Original Medicare has very specific rules about what services it will and will not cover. While the program covers medically necessary inpatient and outpatient healthcare and medical supplies, it doesn’t cover all medical expenses. Which type of care is not covered by Medicare Parts A and B? Examples include routine vision care, hearing aids, dental care, and most long-term care.
Another common question is “Does Medicare pay for prescriptions?” The answer is no. If you want Medicare prescription drug coverage, you can purchase a standalone Part D plan provided by a private insurance company.
What is Medicare Advantage?
Medicare Advantage (also called Part C) refers to Medicare plans that are offered privately through health insurance companies. If you choose to join a Medicare Advantage plan, you still have Medicare; you just receive your Parts A and B coverage through the Medicare Advantage plan.
Medicare Advantage plans come in various forms, including health maintenance organizations (HMOs), preferred provider organizations (PPOs), and private fee-for-service plans. As a Medicare beneficiary, you might not have access to all of these plan types.
Are Medicare Advantage plans worth it?
The answer is that it depends on your unique needs. Medicare Advantage plans cover all of the same services offered under Original Medicare—but they may also cover additional services such as:
- Routine vision care and eyeglasses
- Hearing aids
- Dental care
- Wellness benefits (e.g. health club membership)
With a Medicare Advantage plan, you still pay your monthly Part B premium. On top of that, you may also pay an additional monthly plan premium. Certain services even require you to pay a deductible and a portion of the cost of the services.
Another thing to consider is that Medicare Advantage may not give you as much choice in the providers you see for your care. Many of these private plans have a designated network of providers in the beneficiary’s geographic area. With the exception of emergencies, they may not provide coverage if you decide to visit an out-of-network provider.
Quick-reference guide: Original Medicare vs. Medicare Advantage
This flyer, created with our partners at the Medicare Rights Center, offers a quick reference to help you understand the major differences between Original Medicare and Medicare Advantage plans, including coverage and network options and costs.
Have questions about your current Medicare plan?
Can I change my Medicare plan at any time? What is the highest rated Medicare Advantage Plan? If you have questions about your Medicare coverage, we want to help.
Learn more and connect with a licensed Medicare broker that meets NCOA’s Standards of Excellence. Our brokers are committed to serving your Medicare selection needs and priorities, including helping you understand all of your options, at no cost to you.