What is the difference between Original Medicare and Medicare Advantage plans?

People with Medicare can get their health coverage through either Original Medicare or a Medicare Advantage Plan (also known as a Medicare private health plan or Part C).  Both Medicare and Medicare Advantage are legally required to cover certain basic health services, though the costs you pay and the specific services that are covered vary.

Medicare vs. Medicare Advantage: Differences:

Original Medicare. If you or your spouse worked and paid Medicare taxes, you will most likely receive Part A premium-free with Original Medicare. Part B with Original Medicare has a premium ($170.10 in 2022) and a deductible ($233.00 in 2022). Part B costs are based on your lifetime earnings, so low-income beneficiaries may pay less. With Original Medicare, you can see any medical provider or visit any facility in the country that accepts Medicare.  According to the Kaiser Family Foundation, 93 percent of primary physicians participate in Medicare

Under Part B, beneficiaries are responsible for 20 percent of a doctor visit or lab test bill. There is no out-of-pocket maximum for Original Medicare. A Medigap plan (also called a Medicare Supplement), sold by private companies, can help pay some of the 20 percent Original Medicare doesn’t cover.

Original Medicare does not include prescription drug coverage. You may choose to purchase a stand-alone prescription drug plan from a private company.

Medicare Advantage. Medicare Advantage is a bundled alternative, you will essentially be joining a private insurance plan like you likely had through your employer. Instead of paying the 20 percent coinsurance amount for doctor visits and other Part B services, most MA plans have set copay amounts for each physician visit. The copays, deductibles and other out-of-pocket costs that can make it complicated to predict the actual cost of your health care. Almost all Medicare beneficiaries live in a county where at least one Medicare Advantage plan has some extra benefits not covered by traditional Medicare, with 99% having access to some dental, fitness, vision, and hearing benefits for 2022. The vast majority of beneficiaries also have access to telehealth benefits (99%), over the counter items (99%), a meal benefit (99%), transportation assistance (97%) and but fewer have access to in-home support services (76%) or bathroom safety devices (63%). Medicare Advantage plans are best suited for healthy beneficiaries who don’t use many health care services. Each plan is different, so it is important to compare and review each plan.

You’ll still be required to pay your Part B monthly premiums, unless you sign up for a Medicare Advantage plan with a Part B give back benefit, which covers part or all of your Part B premium. Most plans also include coverage for prescription drugs.

Medicare Advantage plans are based around networks of providers that are usually in a specific geographic area. Most plans require you to go to their network of doctors and health providers.