Original Medicare vs Medicare Advantage

Original Medicare vs Medicare Advantage


Two alternative ways to receive Medicare benefits are Original Medicare (Parts A and B) and Medicare Advantage (Part C). Both alternatives offer the same fundamental level of hospital and medical insurance but have significant variances.

Part A of Original Medicare pays for inpatient hospital and skilled nursing facility care, whereas Part B of Original Medicare pays for doctor visits, outpatient treatments, and some preventative care. Medicare Advantage covers all the plans (Parts A and B), and most policies include prescription medicines (Part D). 

In addition, each Medicare Advantage plan provides additional benefits, which, while they differ by plan and provider, may cover things like dental, vision, and hearing insurance as well as exercise programmes, transportation to doctor’s visits, and more.

The Cost

You will probably have to pay premiums, deductibles, copays, and coinsurance whether you choose Original Medicare or a Medicare Advantage plan.

Original Medicare has the following costs:

  • The Part B surcharge
  • The premium for Part A. Only if you or your spouse spent the previous ten years unemployed and paying Medicare taxes.
  • Expenses for Parts A and B
  • Coinsurance in Part B
  • Parts A and B service copays
  • Extra Part D expenses – You’ll probably have to pay additional premiums, deductibles, copays, and coinsurance if you add a Part D prescription medication coverage.

Medicare Advantage costs vary but may cover the following:

  • The Part B surcharge
  • A cheap or free plan premium
  • A deductible for the plan (not all Medicare Advantage plans have one)
  • Copays for products and services in the health sector that are covered

However, one genuinely lovely advantage of a Medicare Advantage plan is that your out-of-pocket expenses (deductibles, coinsurance, and copays) are restricted. This can significantly lower the cost of your Medicare coverage. Original Medicare does not offer the same kind of monetary security.

The Providers

Men and women analyze the data

What medical professionals can see is the last significant distinction to consider when deciding between Original Medicare and a Medicare Advantage plan. With Original Medicare, you can visit any hospital, physician, or healthcare facility in the United States that accepts Medicare. However, your coverage is constrained when travelling abroad.

Most Medicare Advantage plans feature a network of doctors and other healthcare professionals you can use. You’ll probably have to pay more outside the plan’s network. Emergency and urgent care, however, are covered everywhere. Although some plans might provide extra foreign coverage or travel advantages, you also have restricted coverage abroad. You can enroll via websites like https://www.medisupps.com/.

How Can You Decide Between Medicare Advantage And Original Medicare?

Consider whether you want dental, vision, and other benefits coverage.

A Medicare Advantage plan can be the best option if you desire coverage like dental, vision, or fitness because they include everything Original Medicare covers plus more.

Consider What Your Potential Overall Costs Would Be.

Your overall expenses will change depending on the insurance plan you select and the medical services you receive. But bear the following in mind specifically while comparing which choice best suits your financial circumstances.

  • Medicare Advantage offers built-in financial protection. The annual out-of-pocket maximum allowed can help you keep your expenses in check.
  • If you have Original Medicare, your premiums can be higher. Because you might choose to add a Part D prescription drug plan or other extra coverage, you might have more outstanding monthly premium payments with Original Medicare than with Medicare Advantage.
  • With Medicare Advantage, you might have to pay more copays than with Original Medicare. Your copays with a Medicare Advantage plan may be higher depending on the medical services and providers you utilise if in-network versus out-of-network costs differ.
  • Medicare Advantage offers a yearly out-of-pocket maximum as financial security. Purchasing a Medicare supplement plan will give your Original Medicare additional protection.
  • Since you might add a Part D prescription medication plan and a Medicare supplement plan, your monthly premium payments with Original Medicare could be higher than those with Medicare Advantage.

Think about how frequently you travel.

Original Medicare covers any healthcare facility across the nation that accepts Medicare. You must see providers in the plan’s network to avoid additional fees with most Medicare Advantage plans. Network providers accept the negotiated prices in the plan, allowing you to benefit from the cost savings. If you travel frequently, consider how this affects your Medicare coverage.

The CARES Act of 2020

the cares act

On March 27, 2020, the Coronavirus Aid, Relief, and Economic Security (CARES) Act, a $2 trillion package of relief measures in response to the COVID-19 pandemic, was signed into law by then-President Donald Trump.

It increased Medicare coverage for COVID-19 treatment. Moreover, the CARES Act:

  • Medicare’s telehealth coverage has improved
  • Allowed physician assistants, nurse practitioners, and certified nursing specialists to certify home health services for Medicare
  • Medicare payments for hospital stays and durable medical equipment related to COVID-19 have increased.

The Families First Coronavirus Response Act (FFCRA) made it clear that Medicaid can be used in non-expansion states to pay for COVID-19-related services for uninsured people who would have been eligible for Medicaid if the state had decided to expand. Under this state option, other populations with limited Medicaid coverage are also eligible for coverage.

What Does Medicare Not Cover?

Medicare does not cover specific essential healthcare treatments. Importantly, it does not cover long-term care, sometimes called custodial care. These custodial expenses are covered by Medicaid, a government health programme for low-income people, but not by Medicare. 

Among the other frequent costs that Medicare does not cover:

  • Eye exams and eyeglasses
  • Dentures
  • Most dental care
  • Medical care overseas
  • Cosmetic surgery
  • Massage therapy


As a last point, you can transfer from Original Medicare to Medicare Advantage or vice versa, no matter which choice you determine is best for you. If you qualify, the Medicare Annual Enrollment Period and the Medicare Special Enrollment Period for Qualifying Life Events are the two main occasions you can switch.


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