If you are considering enrolling for Medicare benefits, your first major decision should be deciding whether to enroll for the federally run Original Medicare or purchase a Medicare Advantage plan from a private insurance company. If you are not too sure of how these two plans compare, this guide is for you! Read on to know the difference between Original Medicare and Medicare Advantage.
Under Original Medicare, you can see any health-care provider – specialists and primary care doctors – who accept Medicare. You don’t need a referral to see a doctor and you don’t have to be worried about a certain healthcare provider you visit leaving the network. Under Medicare Advantage, you’ll essentially have to join a private insurance plan (similar to what you did with employer-sponsored medical insurance). The most common ones are preferred provider organizations (PPOs) and health maintenance organizations (HMOs). In the case of Medicare Advantage plans, you will most likely have a primary care provider who will refer you to a specialist, if required.
While Original Medicare covers a lot of things like hospitalizations, diagnostic tests, scans, X-rays, outpatient surgery, and blood work, there are some things it does not cover. These exclusions include cosmetic surgery, vision, dental, etc. Under Medicare Advantage, you are covered for all services that you were eligible for under Original Medicare. Further, Medicare Advantage also offers some additional coverage, like dental, hearing care, and vision. In fact, some Medicare Advantage plans even cover things like gym memberships. Of course, the exact services you will be able to access will vary depending on the plan you choose.
Under Original Medicare, the federal government decides the premiums, coinsurance, and deductibles for both Part A and Part B services. Most people don’t pay a premium for Part A because they’ve paid for it in taxes during their employment years. Part B, however, has a premium. Most people who opt for Original Medicare get a Medigap policy to cover their out-of-pocket expenses. Under Medicare Advantage, enrollees will still need to pay the government-decided annual premium for Part B and sometimes an additional premium from their Medicare Advantage plan. But, Medicare Advantage plans typically have lower out-of-pocket expenses compared to Original Medicare.