Original Medicare and Medicare Advantage
Original Medicare (Parts A & B) and Medicare Advantage (Part C) are two different ways to receive your Medicare benefits/coverage. Both options provide you with hospital and medical insurance, but there are also differences between them.
It’s important to learn about the differences in your coverage options, because the differences will impact your decision when deciding which option is best for you.
With Original Medicare, you can see any doctor or specialist that accepts Medicare, without the need for a referral.
Most Medicare Advantage plans have a provider network, which may restrict your choice of healthcare providers. You will also have medical services that will require prior authorization from the Advantage Plan.
Maximum Out-of-Pocket Costs
Original Medicare has no out-of-pocket maximum unless you purchase a supplemental policy. The supplemental policy (Medigap) will be secondary to Original Medicare and will limit your out of pockets to almost zero yearly.
Medicare Advantage plans have annual out-of-pocket limits. This means that once you reach the limit, a Medicare Advantage plan will cover 100% of your Medicare-approved expenses for the remainder of the year. In 2024 the Out-of-Pocket Limits will depend on the Medicare Advantage Network. Those will range from about $5,000 up to $11,500.
Part D Prescription Drug Coverage
Original Medicare does not include prescription drug coverage—you would need to purchase a separate Part D prescription drug plan. The plan that you select would depend on your combination of prescriptions and pharmacy you use.
Most Medicare Advantage plans include drug coverage. You would want to make sure that the Advantage Plan covers your prescription medication.
Most Medicare Advantage plans include extras such as dental, vision, fitness, hearing, and telehealth benefits.
Original Medicare does not cover these costs. A separate dental/vision plan would need to be purchased if that was an important benefit to you.
Since Original Medicare doesn’t have a provider network, your coverage travels with you. Your Original Medicare benefits are good nationwide.
Medicare Advantage coverage is limited to the plan’s service area, which means your plan may not cover you while traveling (except for emergency care).
Medigap is available to Original Medicare beneficiaries only and is designed to supplement that coverage, for an extra premium.
You can’t purchase a Medigap (Medicare Supplement) policy if you are receiving your benefits through a Medicare Advantage plan.
You can purchase products to help with out-of-pocket expenses in your Medicare Advantage. Some type of indemnity plan would be what you would want to purchase.
Questions to ask
Your Medicare Coverage is very important.
Ask questions if you don’t fully understand your options.
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