Medicare Advantage vs Original Medicare: What are the pros and cons?

Medicare Advantage vs Original Medicare: What are the pros and cons?

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 benefitsYesYes
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 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.

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Medicare Advantage vs Original Medicare: What are the pros and cons?