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- Published: July 16, 2020
- Updated: May 24, 2023
- 10 min read time
- This page features 6 Cited Research ArticlesKey Takeaways
- Original Medicare is administered by the federal government, while Medicare Advantage plans are sold and administered by private insurers.
- Original Medicare Part A is hospital insurance and Part B is medical insurance covering doctor’s visits and other medical services — but does not cover prescription drugs you take at home, vision, hearing and most dental services.
- Medicare Advantage covers everything Original Medicare covers but may also cover prescription drugs as well as hearing, vision and dental services.
- Original Medicare allows you to go to any doctor or hospital in the United States that takes Medicare while Medicare Advantage plans may limit you to a smaller list of doctors, hospitals or other providers.
Pros and Cons of Medicare Advantage Plans vs. Original Medicare
Original Medicare is run by the federal government and is overseen by the U.S. Centers for Medicare & Medicaid Services (CMS). Medicare Advantage is an alternative to Original Medicare. These plans are sold through private insurers who contract with CMS to provide coverage.
Who provides coverage is the biggest difference between the two, but there are several more that you should consider before deciding which option is right for you.
You should compare the pros and cons for both Medicare and Medicare Advantage plans carefully to see how they stack up for your particular health care coverage needs.
Pros and Cons of Original Medicare vs. Medicare Advantage Plans
- Original Medicare: You’ll pay a premium for Medicare Part B and be responsible for a deductible and coinsurance.
- Medicare Advantage: You’ll pay an additional premium on top of your Part B premium, but other cost sharing varies based on your plan.
Choice of Providers
- Original Medicare: You can go to any doctor or facility that accepts Medicare.
- Medicare Advantage: Usually requires you to use doctors and hospitals in the insurer’s network.
- Original Medicare: You can pay an extra premium for supplemental insurance, or Medigap, that covers some out-of-pocket costs.
- Medicare Advantage: You are not allowed to buy Medigap if you have a Medicare Advantage plan.
- Original Medicare: There is no limit on how much you have to pay out of pocket.
- Medicare Advantage: Plans have an annual limit for which you have to pay out-of-pocket costs.
Prescription Drug Coverage
- Original Medicare: You must enroll in a Medicare Part D prescription drug plan for drug coverage.
- Medicare Advantage: Most plans include drug coverage, but you have a higher premium.
Referrals to Specialists
- Original Medicare: You do not need a referral to see a specialist.
- Medicare Advantage: Most plans require you to get a referral from your primary care doctor to see a specialist.
- Original Medicare: Covers only medical and hospital costs.
- Medicare Advantage: Plans may cover prescription drugs, hearing, vision and dental as well as hospital and medical services.
- Original Medicare: Generally only covers you during travel in the United States.
- Medicare Advantage: Plans may cover emergency care in foreign countries but sets a lifetime limit.
Most doctors and hospitals in the United States accept Original Medicare. The federal government also limits how much health care providers can charge people on Medicare whether the doctors or hospitals participate in Medicare or not.
All Medicare Advantage plans must cover the same things Original Medicare covers. But Medicare Advantage plans may also cover other benefits such as hearing, vision, dental and prescription drug coverage.Have you selected your 2024 Medicare plan?Maximize your Medicare savings by connecting with a licensed insurance agent. Annual Enrollment is open until December 7th.
Comparing Medicare Advantage vs. Medicare by Scenario
Your lifestyle, finances and general health play major roles in whether a Medicare Advantage plan or Original Medicare is a better fit for you.
You should consider these qualities before making a choice on the type of coverage you choose.
Who Are Medicare Advantage Plans Good For?
Typically, Medicare Advantage plans make the most sense for people with limited financial resources but who are in good health.
Medicare Advantage plans tend to have lower premiums than Original Medicare. But they require you to spend more out-of-pocket for services they cover.
Who Are Medicare Advantage Plans Bad For?
Medicare Advantage plans may not be a good fit for you if you have chronic or serious health conditions because they can require expensive copays.
Even if you’re healthy now, you should consider your risk for health issues that may require frequent doctor visits and hospitalization in the future. These costs could be much higher under a Medicare Advantage plan.
Since Medicare Advantage plans have provider networks that limit which doctors and other providers you can see, they are not a good choice if you want the option of choosing your own doctor — or if you travel or live part of the year in another part of the country.
It can also be difficult — and expensive — to switch from a Medicare Advantage plan to Original Medicare with Medigap coverage if you later decide that’s a better option for you.
When Original Medicare Coverage Makes Sense
Original Medicare is a better choice if you have serious health conditions or expect them in the future. While monthly premiums may be higher, the coinsurance and other out-of-pocket costs associated with doctor visits and other health care services may be less expensive in the long run.
In addition, you can modify your Original Medicare coverage to help offset your out-of-pocket costs through a Medigap policy and a Medicare Part D prescription drug plan. These offer you combinations of coverage that can further reduce your costs in the long run.
Medicare Supplemental Insurance — Medigap
Medicare Supplemental insurance — better known as Medigap — plans are standardized policies you purchase through private insurers.
To buy a Medigap plan, you first must enroll in both Medicare Part A and Part B. Medigap works with Original Medicare to help you pay out-of-pocket costs that Medicare does not cover, such as copays and coinsurance.
A Medigap plan can reduce your out-of-pocket costs, but it won’t pay for all of them.
Medigap does not cover your Plan A deductible. If you were not eligible for Medicare until Jan. 1, 2020 or later, Medigap plans will no longer cover your part B deductible.
It also won’t pay for anything that Medicare Part A and Part B does not cover — such as vision, dental or hearing services.
You can’t add a Medigap policy to a Medicare Advantage plan. You must have Original Medicare.
Medicare and Prescription Drug Coverage
You can add a Medicare Part D prescription drug plan to Original Medicare to help cover the cost of prescription drugs you take at home.
Medicare Part D plans are sold by private insurers. They may require you to use a pharmacy in the plan’s network.
You should also check with the plan administrator and your doctor to make sure that any specific medications you take — especially brand name drugs — are covered, and if not, then a different drug that will work for your condition.
Is Medicare Advantage or Original Medicare Right for You?
Medicare Advantage plans have become a growing share of coverage for retirees since it first appeared in 1995 since they provide popular options missing from Original Medicare.
Medicare Advantage plans create their own networks of doctors and hospitals who agree to set prices. This can limit your choice of doctors or hospitals that you have under Original Medicare. But Medicare Advantage provides a wider array of options for people willing to pay for them.
Part C plans may not be right for everyone. A government review suggested that Medicare Advantage plans appear to be a better fit for healthier patients.
“We found some [Medicare Advantage] contracts in which people in poor health were much more likely than others to voluntarily leave the contracts’ health plans,” authors of a 2017 Government Accountability Office Report to Congressional Requesters wrote.
The GAO found these plans often had lower quality scores and enrollees cited problems with getting access to health care through the plans.Reasons People Gave for Dropping Their Medicare Advantage Plan
- Preferred doctors or hospitals not in the plan’s network
- Problems with costs
- Difficulty getting needed care
- Problems getting information on drugs
- Issues with drug coverage
Looking carefully at a Medicare Advantage plan or working closely with with a licensed professional insurer to make sure you are getting the kind of coverage you want can help you select the plan that’s best for your particular situation.3 Minute Quiz: Can You Retire Comfortably?Take our free quiz & match with a financial advisor in 3 easy steps. Tailored to your goals. Near you or online.
Can You Switch Medicare Plans?
You can join, switch or drop Medicare or Medicare Advantage plans, but you can only do it at certain times and under certain conditions.
Enrollment Periods for Switching Medicare Plans
You are limited to joining, dropping or switching Medicare plans to certain times — called enrollment periods.Medicare and Medicare Advantage Enrollment Periods
- Initial enrollment period
- You can enroll in a plan when you first become eligible for Medicare. This is a seven-month period that starts three months before you turn 65, includes the month you turn 65 and lasts through the three months after the month you turn 65. You can sign up for Medicare, Medicare Advantage, Medigap or Medicare Part D prescription drug plans during this time. If you don’t sign up for Medicare during this period, you can face Medicare late enrollment penalties.
- Open enrollment period
- This period runs from Oct. 15 through Dec. 7 each year. During open enrollment, you can join, switch or drop a Medicare plan. Your new coverage will start on Jan. 1 of the following year.
- Medicare Advantage open enrollment period
- This period runs from Jan. 1 through March 31 each year. During this period, if you are enrolled in a Medicare Advantage plan, you can switch to another Medicare Advantage plan. You can also switch once from Medicare Advantage to Original Medicare and buy a separate Medicare Part D prescription Drug plan.
- Medigap open enrollment period
- This period runs for six months after the first month you have Medicare Part B health insurance and are 65 and older. Medigap insurers are required to sell you a Medigap plan if you want one during this time. If you wait, you may not be able to buy Medigap or you may be charged more for a plan.
You can also change plans under special circumstances — called special enrollment periods. Circumstances include moving to a new area where your Medicare Advantage plan doesn’t serve you or the company goes out of business.
How to Switch Medicare Plans
To switch from Original Medicare to a Medicare Advantage plan, you will need to make the move during the annual open enrollment period or during a special enrollment period.To switch from your current Medicare Advantage plan, there are a couple of options:Read More About Choosing a Medicare Plan
- To switch to a new Medicare Advantage plan, join the new plan you want during the open enrollment period and the coverage will switch automatically.
- To switch from Medicare Advantage to Original Medicare, contact your current plan’s administrator or call Medicare at 1-800-633-4227.
Medicare Advantage vs. Medicare FAQsWhat's the difference between Original Medicare and Medicare Advantage?
Original Medicare is a federal program that is provided by the government. Medicare Advantage is available through private insurers, with plans varying depending on where you live in the U.S.Is Medicare Advantage more expensive than Medicare?
It can be. Medicare Advantage plans include expanded benefits and coverage that go beyond the scope of Original Medicare such as vision, dental and Part D prescription drug coverage.Does getting a Medicare Advantage plan make you lose Original Medicare?
Medicare Advantage is an alternative to Original Medicare, but every plan must include at minimum the same coverage that is available through Original Medicare. So you can never end up with less coverage from Medicare Advantage than you would have from Original Medicare. If you’re eligible for Original Medicare, then you should be for Medicare Advantage, as well.Last Modified: May 24, 2023
6 Cited Research Articles
- Freed, M. & et al. (2022, August 25). Medicare Advantage in 2022: Enrollment Update and Key Trends. Retrieved from https://www.kff.org/medicare/issue-brief/medicare-advantage-in-2022-enrollment-update-and-key-trends/
- U.S. Centers for Medicare & Medicaid Services. (2019, September 24). Trump Administration Drives Down Medicare Advantage and Part D Premiums for Seniors. Retrieved from https://www.cms.gov/newsroom/press-releases/trump-administration-drives-down-medicare-advantage-and-part-d-premiums-seniors
- Liaise, E. (2018, May 23). Medicare vs. Medicare Advantage: Ill Health Often Leads to Plan Switch. Retrieved from https://www.kiplinger.com/article/retirement/t039-c000-s004-medicare-vs-medicare-advantage-ill-health-switch.html
- Graham, J. (2017, October 19). Medicare vs. Medicare Advantage: How to Choose. Retrieved from https://khn.org/news/medicare-vs-medicare-advantage-how-to-choose/
- U.S. Government Accountability Office. (2017, April). Medicare Advantage; CMS Should Use Data on Disenrollment and Beneficiary Health Status to Strengthen Oversight. Retrieved from https://www.gao.gov/assets/gao-17-393.pdf
- Blue Cross Blue Shield Blue Care Network of Michigan. (2019, October 8). What’s the Difference Between Original Medicare and Medicare Advantage? Retrieved from https://www.bcbsm.com/medicare/help/faqs/works/difference-original-medicare-advantage.html
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