While there are many similarities between Original Medicare and Medicare Advantage, they're actually quite different. With Original Medicare, your benefits are administered by the federal government and include Part A and Part B. Part A is your hospital coverage and Part B is your medical coverage. You pay into both of these parts during your working career through Medicare taxes.
With Medicare Advantage, your benefits are managed through a private insurance company. Medicare pays the Medicare Advantage carrier to administer your benefits for both Part A and Part B. When Medicare Advantage is administering your benefits, it's known as Part C. These private insurance companies must follow the guidelines that the federal government sets in place.
Now that we've gone over the basic difference between the two, let's go over the pros and cons.
Original Medicare Pros:
• Benefits are identical from person to person • There are no copays, no waiting periods, and no pre-existing condition limitations • There are no networks, meaning you can see any doctor that accepts Medicare • Any out-of-pocket costs will be the same regardless of the provider you choose •Your coverage will also travel with you across the United States
Original Medicare Cons:
• Both Part A and Part B come with a deductible and coinsurance • No maximum out-of-pocket • No coverage for prescription drugs
Medicare Advantage Pros: • Some areas have plans with $0 premiums • Some plans have a Part B give-back option • Plans have an out-of-pocket maximum limit • Can come with additional perks like dental, vision, and hearing benefits, gym memberships, and long-term care • Many plans include coverage for prescription medications
Medicare Advantage Cons:
• Benefits are different from plan to plan • You still need to pay your Part B premium • Limited doctor networks and need for a referral to see a specialist • High cost per service • Plans do not travel with you • Maximum out-of-pocket limit could still break the bank
Now that we've discussed the pros and cons of both, let's go over how doctor visits, covered services, and costs work.
Doctor Visits on Original Medicare:
• When you have Original Medicare, you can see any doctor or specialist that accepts Medicare without needing a referral • Plans don't change annually, so you don't have to worry about your doctor leaving the plan's network
Doctor Visits on Medicare Advantage:
• Most plans are HMOs or PPOs and you'll have a primary care physician to direct all your care – therefore, you'll need a referral to see a specialist • Physicians can leave the plan's network at any time
Covered Services on Original Medicare:
• A wide range of services are covered • Does not include coverage for routine dental, vision, or hearing care
Covered Services on Medicare Advantage:
• Includes coverage for the same services Original Medicare covers plus possible coverage for dental, vision, and hearing
Costs on Original Medicare:
• Part A and Part B both come with a deductible and coinsurance • You will pay a monthly premium for Part B • No maximum out-of-pocket limit • The Part A deductible is per benefit period
Costs on Medicare Advantage:
• You still need to pay your Part B premium in order to be eligible for a Medicare Advantage Plan
So, which is better –Original Medicare or Medicare Advantage? This answer depends on your specific situation and your health care coverage goals. If you're looking to cover the gaps in Original Medicare, then the best option for you might be a Medigap plan in combination with a Part D prescription drug plan. If you can't enroll in a Medigap plan, then having Medicare Advantage is better than just having Original Medicare
Hi Medicare Community. If you're not sure if you should keep Original Medicare or go with Medicare Advantage, don't go anywhere. In today's video, we're going to compare them side by side so you can make the best choice for you. Hi everyone. I'm Lindsay Engle. I'm the Medicare expert for Elite Insurance Partners and MedicareFAQ.com. While there are many similarities between Original Medicare and Medicare Advantage, they're actually quite different. With Original Medicare, your benefits are administered by the Federal Government. Your benefits include Part A and Part B. Part A is your hospital coverage and Part B is your medical coverage. You pay into both of these parts during your working career through Medicare taxes. With Medicare Advantage, your benefits are managed through a private insurance company. Medicare pays the Medicare Advantage carrier to administer your benefits for both Part A and Part B. When Medicare Advantage is administering your benefits it's known as Part C. These private insurance companies must follow the federal guidelines that the government sets in place. Now that we've gone over the basic differences between the two, let's go over the pros and cons. First, let's go over the pros and cons of Original Medicare. With Original Medicare. The benefits are identical from person to person. There are no co-pays, no waiting periods, and no pre-existing condition limitations. There are also no networks. You can see any doctor that accepts Medicare. Any out-of-pocket cost will also remain the same regardless of the provider you choose to receive care from. Your coverage will also travel with you or across the United States. Both Part A and Part B come with a deductible as well as coinsurance. Another downside is that Original Medicare has no Maximum Out-of-Pocket. So you can rack up medical bills with no limit to how much you responsible for paying out-of-pocket. There's also no coverage for prescription drugs. Next, let's go over the pros and cons of Medicare Advantage. In some areas, there are plans with $0 premiums is available. Some also have a Part B give back option built-in. They have an Out-of-Pocket Maximum limit. Medicare Advantage plans can come with additional perks like dental, vision, and hearing benefits. Some plans may even include gym memberships as well as long-term care benefits. Many Part C plans also include coverage for prescription medications. Now, with Medicare Advantage the benefits are different from plan to plan. And you do still have to pay your Part B Premium. The biggest downfall to Medicare Advantage is the limited doctor networks. Access to care can be more challenging. You also need a referral to see a specialist. Another con to Part C plans is the high cost per service. Yes, $0 to low premiums are appealing, but when you additional out-of-pocket cost you pay as you use the benefits, some may find it's just not worth it. Unlike Original Medicare Medicare Advantage plans come with annual coverage changes. The plan that works for you now, may not work for you next year. These plans also do not travel with you. Lastly, the Maximum Out-of-Pocket limit can still break the bank. Now that we've gone over both the pros and cons of Original Medicare and Medicare Advantage. Let's go over a little bit more in detail on how doctor visits, covered services, and cost work. With doctor visits, when you have Original Medicare, you can see any doctor or specialist that accepts Medicare. You don't need a referral to see a specialist either. Since plans don't change annually, you won't need to worry about your doctor leaving the plans Network. However, when you have Medicare Advantage, your coverage will be very similar to employer group coverage. The majority of them are HMO and PPOs. You will have a primary care physician that directs all your care. Therefore, you'll need a referral to see a specialist. Physicians are also able to leave the network of the plan at any time. So you could find yourself searching for a new primary care physician at any point of the year without notice. With original Medicare, you have a wide range of medical services that are covered. This includes diagnostic tests, durable medical equipment, outpatient surgery, hospitalization, preventive services, and much more. However, Original Medicare does not include coverage for routine Dental Care, Vision, or Hearing Care. With Medicare Advantage, you'll have coverage for the same services Original Medicare covers. In addition, you could also have coverage for some dental, vision, and hearing care. The downside is you may have trouble finding a dentist, eye care practitioner, or audiologist that accepts Medicare Advantage. And the benefits are usually very limited. Now, let's go over the cost. When you have Original Medicare, Part A and Part B both come with a deductible and coinsurance. The Part A deductible changes annually and so does the Part B deductible. Part B also has a 20% coinsurance that you have to pay out-of- pocket for all of your outpatient services. So if you stick with just Original Medicare, Part A you pay nothing monthly. Part B, you have a monthly premium. And then you end up paying the 20% coinsurance whenever you go to use services in an outpatient facility. Since there's no Maximum Out-of-Pocket limit with Original Medicare, that 20% coinsurance under Part B can quickly add up. In addition, the Part A deductible is not annual. It is per benefit period. That means that you could end up paying the deductible for Part A multiple times throughout the year. The biggest misconception with Medicare Advantage is that you don't have to pay your Part B premium. This is false. You still have to pay your Part B premium in order to be eligible for Medicare Advantage plan. So if there's no $0 premium plans available in your area from Medicare Advantage, you'll be paying the Part B premium, in addition, you are also paying the premium for the Medicare Advantage plan. So, which is better? Original Medicare or Medicare Advantage. Well, there is no easy answer. It really depends on your specific situation and what your goals are with your health care coverage. If you're looking to fill in the gaps in coverage that come with Original Medicare, then the better option for you maybe a Medigap plan in combination with the Part D prescription drug plan. If you cannot enroll in a Medigap plan for one reason or another, then a Medicare Advantage plan is better than having just Original Medicare. Thank you so much for watching today. I hope you found this video helpful. If you did, don't forget to subscribe to our YouTube channel, make sure to turn notifications on so you're notified each time we upload a new video. 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