Comparing Medicare & Medicare Advantage

What's the difference between Original Medicare Coverage and Medicare Advantage Plans?

As opposed to Medicare Supplement, or “Medigap”, Medicare Advantage, also known as “Part C”, actually replaces your Original Medicare, Parts A & B, coverage. But, there are differences between Part C and Original Medicare coverage.

DOCTORS (Original Medicare) DOCTORS (Medicare Advantage)
You can go to ANY doctor or hospital that takes Medicare, anywhere in the U.S. Typically need to use in-network health care providers within a service area for the lowest costs. Some plans won’t cover services out of network or service area.
Typically do NOT need a referral to see a specialist. May need a referral to see a specialist.
COSTS (Original Medicare) COSTS (Medicare Advantage)
For Part B-covered services, you usually pay 20% of the Medicare-approved amount after you meet your deductible. This is called your coinsurance. Out-of-pocket costs vary—plans may have lower out-of-pocket costs for certain services.
Pay a premium for Part B. If you choose to join a Medicare drug plan (Part D), you’ll pay that premium separately. You may pay the plan’s premium in addition to the monthly Part B premium. (Most plans include drug coverage) Plans may have a $0 premium or may help pay all or part of your Part B premiums.
There’s no yearly limit on what you pay out of pocket, unless you have supplemental coverage—like Medicare Supplement Insurance (Medigap). Plans have a yearly limit on what you pay out of pocket for services Medicare Part A and Part B covers. Once you reach your plan’s limit, you’ll pay nothing for services Part A and Part B covers for the rest of the year.
You can get Medigap to help pay your remaining out-of-pocket costs (like your 20% coinsurance). Or, you can use coverage from a former employer or union, or Medicaid. You can’t buy and don’t need Medigap.
COVERAGE (Original Medicare) COVERAGE (Medicare Advantage)
Original Medicare covers most medically necessary services and supplies in hospitals, doctors’ offices, and other health care settings. Original Medicare doesn’t cover some benefits like eye exams, most dental care, and routine exams. Plans must cover all of the medically necessary services that Original Medicare covers. Most plans offer extra benefits that Original Medicare doesn’t cover, like some vision, hearing, dental, and routine exams.
You can join a separate Medicare drug plan (Part D) to get drug coverage. Drug coverage (Part D) is included in most plans. In most types of Medicare Advantage Plans, you don’t need to join a separate Medicare drug plan.
In most cases, you don’t have to get a service or supply approved ahead of time for Original Medicare to cover it. In some cases, you have to get a service or supply approved ahead of time for the plan to cover it.
TRAVEL (Original Medicare) TRAVEL (Medicare Advantage)
Original Medicare generally doesn’t cover care outside the U.S. You may be able to buy a Medicare Supplement Insurance (Medigap) policy that covers care outside the U.S. Plans generally don’t cover care outside the U.S.
Comparing Medicare & Medicare Advantage