Original Medicare Part A and B and Medicare Advantage Part C

Original Medicare and Medicare Advantage: Which one do I have?

Original Medicare and Medicare Advantage are two different types of medical insurance offered by the federal government for those who are 65 or older. They are also available for some people with disabilities.

Both options provide coverage for doctor visits, hospital stays, and other medical expenses. But they differ in terms of plan network, monthly premiums, and out-of-pocket costs. 

What is Original Medicare?

Original Medicare includes Part A and Part B. Part A covers hospital stays, hospice care, and some home health care. Part B covers doctor visits, lab tests, and other medical services. Together, these two parts provide a comprehensive package of medical insurance.

The cost of Original Medicare is determined by the federal government and is based on your income and other factors. The Part B premium, for example, is typically higher for those with higher incomes.3

What is Medicare Advantage?

Medicare Advantage, also known as Medicare Part C, is a type of medical insurance offered by private insurance companies. These plans provide all of the coverage that Original Medicare does, but they may also include additional benefits such as vision, hearing, and dental coverage. Medicare Advantage plans also have a network of providers that you must use in order to receive coverage.

Original Medicare vs. Medicare Advantage

When it comes to Medicare coverage, individuals have the option to choose between Original Medicare or a Medicare Advantage Plan (also known as a Medicare Part C). It’s important to be aware of the key differences between these two options in order to make an informed decision on how to receive your Medicare benefits.

Original Medicare is the original and traditional program offered by the federal government. 

  • It comprises two parts, Part A which covers inpatient or hospital care, and Part B which covers outpatient medical care. 
  • It is accepted by most doctors across the country and it has limits on the charges that beneficiaries can incur when visiting participating or non-participating providers. 
  • Beneficiaries will be provided with a red, white, and blue card that they can show to providers when receiving care.

Medicare Advantage is an alternative to Original Medicare, 

  • It’s provided by private insurance companies that contract with the federal government to offer Medicare benefits. 
  • These plans must provide the same benefits as Original Medicare but may have different rules, costs, and restrictions. 
  • Additionally, Medicare Advantage plans may provide additional benefits that Original Medicare does not offer. Some of the most common types of plans are Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and Private Fee-For-Service (PFFS) plans. 
  • When receiving care, beneficiaries will show the membership card from their plan instead of the red, white, and blue card.

The table below compares Original Medicare and Medicare Advantage. 

 

Original Medicare (Medicare A and B)

Medicare Advantage Plans (Part C)

Main difference

Medicare pays providers the Medicare-approved rates for covered services per Medicare rules and regulations. Your providers bill Medicare.

Medicare pays private health plans that have contracts with Medicare to provide all medically-necessary health care that Original Medicare (Parts A and B) cover. Your providers bill your Medicare Advantage plan.

Costs

You pay Medicare Parts A and B premiums, deductibles and coinsurances.

Part A is free if you or your spouse have paid taxes while working a minimum of 10 years (if not, you may pay a premium). For most people, the Part B cost is $148.50 in 2021.

You pay Medicare Parts A and B premiums, and your Medicare Advantage Plans premium, if it charges one, and possible deductibles and coinsurances. 

Part A is free if you or your spouse have paid taxes while working a minimum of 10 years (if not, you may pay a premium). For most people, the Part B cost is $148.50 in 2021.

Supplemental insurance

You may be able to buy a Medigap policy. Other insurance, such as retiree, employer or union plans may supplement Medicare.

You can’t buy a Medigap policy to help pay your out-of-pocket costs in a Medicare Advantage plan.

Covers extra services like vision and dental?

No. Covers medically-necessary inpatient and outpatient health care. Doesn’t cover certain services such as routine vision, hearing or dental care.

Maybe. May cover some services Original Medicare doesn’t cover such as routine vision, hearing and dental care. All plans must cover the same inpatient and outpatient services Original Medicare covers.

Allows me to see providers nationwide?

Yes. You can go to any doctor or hospital in the U.S. that accepts Medicare.

Usually not. Most people have HMOs, which typically have local networks of providers you must use for the plan to cover your care. PPOs plans should cover care you get outside the network, but you will pay more.

Need referrals to see a specialist?

No. You don’t need a referral.

Maybe. You may need to get a referral from your primary care doctor if you want to see a specialist.

Covers drugs?

No, but if you want Medicare prescription drug coverage, you can buy a separate Part D plan.

Usually. Most plans include Part D drug coverage. In Washington state, if you are enrolled in a Medicare Advantage plan, you cannot buy a standalone Part D plan. If you do, you’ll automatically get disenrolled from your Medicare Advantage plan and enrolled in Original Medicare.

Out-of-pocket limits?

No. There’s no cap on what you spend on health care.

Yes. Plans must have an annual out-of-pocket limit, which can be high, but protect you if you need expensive care. The plan pays the full cost of your care after you reach the limit.

How do I know if I have Original Medicare or a Medicare Advantage?

To determine if you have Original Medicare or a Medicare Advantage plan, check your enrollment status. This will reveal the name of your plan, the coverage it provides, and how long you have been enrolled in it.

Do Medicare Advantage Plans Replace Original Medicare?

It’s important to note that Medicare Advantage plans can serve as a replacement for Original Medicare and also provide additional coverage, depending on the plan you choose. These plans are provided by private insurers. They offer the same coverage as Part A and Part B plus additional benefits that Original Medicare does not cover. Therefore, Medicare Advantage plans can be seen as a comprehensive option for your healthcare needs.

Original Medicare is better if you:

  • value provider flexibility, 
  • are a frequent healthcare user, 
  • can afford a Medicare Supplement Insurance plan, 
  • plan to travel during your retirement, and prefer to minimize risk. 
  • You have the ability to see any medical provider or visit any facility in the country that accepts Medicare. 
  • Additionally, if you have a chronic health condition or seek regular healthcare, you have more choices for care under Original Medicare. 
  • You also have the option to purchase a Medigap plan. It can cover certain deductibles, copays, and coinsurance for treatment under Medicare Part A and Part B.

Consider Medicare Advantage Plan if you:

  • Live in an area with a wide range of providers and top-notch hospitals.
  • Can’t afford a Medicare Supplement Insurance plan.
  • Are willing to work within a network of providers and get referrals for out-of-network care.
  • Do not mind being responsible for deductibles, copays, and coinsurance, and meeting the out-of-pocket maximum of the plan.

Original Medicare provides coverage for durable medical equipment, skilled nursing facility care, and Part B medical insurance. It also includes prescription drug coverage and preventive services. Medicare Advantage plans, offered by private companies, may also include coverage for hearing aids and additional prescription drug coverage.

Need help? Call Brady Insurance Marketing: 801-347-2087Our assistance is at no cost to you.



Call Now Button