Choosing how you get your Medicare coverage is an important decision. You have two main options: Original Medicare or a Medicare Advantage Plan. Both choices are offered through Medicare, but they work in different ways. This guide will help explain the differences so you can decide which may fit your needs.
Original Medicare is the traditional program run by the federal government. It includes:
Part A (Hospital Insurance): Covers hospital stays, skilled nursing facilities, hospice, and some home health care.
Part B (Medical Insurance): Covers doctor visits, outpatient care, preventive services, and some medical equipment.
With Original Medicare, you can see any doctor or hospital that accepts Medicare. You may also choose to buy a separate Medigap policy to help pay for costs like deductibles and coinsurance. Prescription drug coverage is not included, but you can add a separate Part D plan.
Medicare Advantage (also known as Part C) is offered by private companies that contract with Medicare. These plans include all the services covered under Part A and Part B. Most Medicare Advantage Plans also include prescription drug coverage (Part D).
Many plans may also include services not covered by Original Medicare, such as vision, dental, hearing, and wellness programs. Each plan has its own list of doctors, hospitals, and rules for getting care, which means you may need to use providers in the plan’s network.
Here are some important points to think about when comparing:
Provider Choice: Original Medicare lets you go to any doctor or hospital that accepts Medicare. Medicare Advantage usually has a network of providers you need to use.
Costs: Original Medicare has standard costs for services, but you may want a Medigap policy to help with out-of-pocket expenses. Medicare Advantage often has set copayments and an annual limit on what you spend.
Prescription Drugs: With Original Medicare, you need to sign up for a separate Part D plan. Most Medicare Advantage Plans include drug coverage.
Coverage Options: Medicare Advantage Plans may include vision, dental, hearing, and wellness. Original Medicare does not cover these services unless you buy other coverage.
The choice depends on your personal situation. Here are some questions to consider:
Do you want the freedom to see any Medicare-approved doctor or hospital?
Are you comfortable with using a provider network?
Do you take prescription drugs, and how do you want that coverage included?
What is most important to you: flexibility, costs, or having more services in one plan?
Both Original Medicare and Medicare Advantage provide reliable coverage. Understanding how each one works can help you make the decision that fits your health and budget. Take time to review your options each year during Medicare’s Open Enrollment Period to be sure your choice continues to meet your needs.
A Licensed Sales Agent can provide valuable guidance when exploring Medicare Advantage Plan options. We can review the plans available in your area, help you compare costs and benefits, and explain enrollment periods and eligibility so you can make an informed decision.
