The Difference between Original Medicare and Medicare Advantage

Over 20% of Medicare patients are enrolled in Medicare Advantage Plans, confirming that these privately run companies do, indeed, offer a viable alternative to the original Medicare Plan. 

All Medicare Advantage Plans, approved by Medicare and often referred to as “Part C”, must include hospital and medical insurance, and are required to cover the same medically necessary services as Original Medicare. There are, however, some fundamental differences which set them apart. 

Medicare Advantage plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for Services (PFFSs), Medical Savings Accounts (MSAs), and Special Needs Plans (SNPs).  One of the key differences between an Original Medicare Plan and one of these Advantage Plans is that an Advantage Plan usually limits your choice of doctors and hospitals, requiring you to choose one from their provider network, while Original Medicare allows you to go to any doctor or hospital that accepts Medicare.  If you do go to a doctor who is not on a provider network, you may be responsible for covering the cost of care.  Some plans, for a higher fee, allow you to select a doctor who is not an approved provider or use an outside doctor who will agree to their terms of payment before treating you.

Medicare Advantage Plans also often provide extra benefits not traditionally covered by Original Medicare, like preventive, vision, hearing, dental and, in many cases, prescription drug coverage.  The added coverage offered by a Medicare Advantage Plan can be a vital help for people requiring these services.

 When choosing a plan, consider the cost, benefits, and convenience of each.  Visit www.medicare.gov or call 1-800-663-4227 for help.  By weighing your choices carefully, you can choose the plan that’s best for you.