What are Medicare Advantage and Original Medicare?
Original Medicare (Parts A and B)
Original Medicare (Parts A and B) is a U.S. government health insurance program for individuals 65 and older, as well as individuals who qualify for disability.
- Medicare Part A is hospital insurance that covers inpatient services. Premiums may not apply for those who have worked for at least 10 years, paying Medicare taxes. Deductible and coinsurance/payments may also apply.
- Medicare Part B is medical insurance that covers preventative services, doctor visits, lab tests, durable medical equipment and other medically necessary services. Monthly premiums usually apply, and deductible and 20% co-insurance apply for most services.
Both Parts A and B come directly from the government.
You may choose to obtain Parts A and B benefits through Medicare Advantage plans offered through private insurers.
Medicare Advantage (Medicare Part C)
Medicare Part A and Part B benefits are also provided through private insurance companies that are contracted by Medicare.
Individuals are still in the Original Medicare program so premiums for Part B still apply.
At a Glance - Main Differences between Medicare Advantage and Original Medicare
|Benefit or feature||Medicare Advantage|| Original Medicare (Parts A and B)|
|Medicare Part A and Part B benefits||Yes||Yes|
|Prescription drug coverage||Yes, with many plans (but not all). Try our Medicare Cost Revealer to compare plans that cover your prescription medications.||Includes only limited prescription drug coverage. Original Medicare doesn't cover most medications you take at home.|
|Additional benefits beyond Part A and Part B, such as routine vision or hearing care ||Yes, with many plans (but not all). Extra benefits may vary among plans.||Generally, no|
|Choice of any doctor who accepts Medicare assignment||Not with every plan. Many plans require you to stay within the plan's provider network.||Yes|
|Generally covers non-emergency care anywhere in the United States ||Usually, no. You must live within the plan's service area, although plans typically cover emergency care when you're away from home in the U.S.||Generally, yes.|
|Maximum out-of-pocket spending limit.||Yes. Once you've reached this limit within a calendar year, the plan may cover your medical costs for the rest of the year. This limit varies among plans and may change year to year.||No|
When to Choose
Typically, individuals are automatically enrolled in Original Medicare upon eligibility and always have the option of moving to Medicare Advantage.
However enrollment in a Medicare Advantage plan requires self registration during open enrollment periods.
Medicare Advantage Enrollment Options
- An Initial Enrollment Period for Medicare Advantage applies within the first 7 months of Original Medicare eligibility.
- The Annual Election Period (AEP) also known as "Fall Open Enrollment", occurs every year from October 15 to December 7. You can switch between different plans and/or change coverage options during this period.
- A Special Enrollment Period (SEP) allows you to qualify under specific circumstances. These typically apply to loss of coverage such as losing employer-based health insurance. Individuals can check eligibility for SEP by contacting Medicare at Medicare.gov or 1-800-MEDICARE (633-4227); TTY users, call 1-877-486-2048; 24/7.
- Individuals enrolled in Medicare Parts A and B and who live in the plan's service area.
- Individuals with end-stage renal disease such as permanent kidney failure - call the plan to confirm eligibility. In this case, you may qualify under the Special Needs Plan.
Try Medicare Helper's Medicare Cost Revealer to compare plans in your area.