What is the difference between regular Medicare and Medicare advantage?

Original Medicare covers hospital and skilled nursing services for inpatients (Part A) and doctor visits, outpatient services, and some preventive care. Part B. Medicare Advantage plans cover all of the above (Part A and Part B), and most plans also cover prescription drugs (Part D). People with Medicare can get their health coverage through the Original Medicare or Medicare Advantage plan (also known as a Medicare private health plan or Part C).

Consider the following key differences between these two options when deciding how you want to receive your Medicare benefits. The following table compares Original Medicare and Medicare Advantage. Remember that there are several different types of Medicare Advantage plans. If you're interested in joining a plan, talk to a plan representative for more information.

Medicare Advantage began in 1995, although similar programs were already available in the 1970s. The key difference between the two programs is that Medicare is government health insurance, while Medicare Advantage is private health insurance that the government helps fund. With original Medicare, you can access care anywhere in the United States as long as the provider accepts Medicare. You pay the premiums, deductibles, and coinsurance for Medicare Parts A and B.

And in recent years, the federal government has been adding services that these plans can offer, such as home improvements, such as wheelchair ramps to help Medicare beneficiaries stay home, provide transportation to doctor's offices and receive meals at home. With Medicare Advantage, you'll basically join a private insurance plan like the one you probably had through your employer. Both Medicare and Medicare Advantage also has a legal obligation to cover certain basic health services, although the costs you pay and the specific services that are covered vary. But keep in mind that if you're looking for a new doctor, 30 percent of primary care doctors don't accept new Medicare patients, so you'll want to ask about it.

Most plans offer additional benefits that Original Medicare doesn't cover, such as some routine exams and eye, hearing, and dental services. In most cases, a service or supply doesn't need to be approved in advance for Original Medicare to cover it. By contrast, with Medicare Advantage plans, you get your benefits from private health insurance companies that Medicare has approved. Both Medicare and Medicare Advantage will fund most basic health costs, including doctor visits and hospitalizations.

In some States, if you're enrolled in a Medicare Advantage plan, you can't buy a separate Part D plan. However, there are significant differences in how you'll use Medicare depending on whether you choose Original or Advantage. If you decide to opt for Part C, a Medicare Advantage plan, it will be more like a fixed menu since a private insurer has already grouped parts A and B and, most often, parts D into a comprehensive plan. While Medicare will cover most of your medical needs, there are some things the program doesn't usually pay for, such as cosmetic surgery or routine dental, eye, and hearing care.

Plans have an annual limit on what you pay out of pocket for services covered by Medicare Part A and Part B.

Elise Woehl
Elise Woehl

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