Original Medicare vs. Medicare Advantage: Which One is Right For You?

Choosing the right Medicare plan can feel daunting. After all, you don’t want to get stuck with a plan or policy that doesn’t meet your needs. Thankfully, there are just two basic options when it comes to acquiring Medicare Part A and Medicare Part B. In this guide, we will look at Original Medicare vs. Medicare Advantage, including what they provide, how they work, and the pros and cons of each.

What is Original Medicare and How Does It Work?

Original Medicare is the standard public health insurance for people aged 65 or older. It has two parts: Part A and Part B. Part A covers inpatient hospital care, hospice and nursing home care, as well as some home healthcare benefits. Alternatively, Part B covers outpatient care, including doctor’s visits, ambulance services, Durable Medical Equipment (DME), mental healthcare, outpatient surgery, lab tests, and some preventative care. However, Original Medicare doesn’t cover all of the costs of these services. As with most insurance plans, you’ll need to meet an annual deductible before Medicare starts paying. Once you’ve met the deductible, Medicare will pay 80% of the cost, while you will pay 20% out of pocket (plus your monthly premiums).

Most people are automatically enrolled in Original Medicare when they turn 65. However, if you are 65 and have not started receiving Social Security benefits, you will not be enrolled yet. Instead, you will need to contact the Social Security Administration when you are ready to enroll in Original Medicare.

What is Medicare Advantage and How Does It Work?

Medicare Advantage provides the same benefits as Original Medicare, but it’s brokered through a private health insurance provider. In other words, you get all the benefits of Medicare Part A and Part B, but it won’t come from the government. Instead, you will have a private health insurance plan. Plus, most Medicare Advantage plans offer benefits beyond what Original Medicare provides. For example, Original Medicare doesn’t have prescription drug coverage. To get drug coverage, you would either need to get a standalone Part D plan or a Medicare Advantage plan. In addition to prescription drug coverage, most Medicare Advantage plans provide some coverage for vision, dental, hearing, and even wellness programs.

Original Medicare vs. Medicare Advantage Pros and Cons 

There are a few pros and cons to both Medicare Advantage and Original Medicare. Let’s take a closer look at each type of insurance.

Original Medicare – Pros

• Offers some of the best healthcare premiums for seniors
• If you already get SS benefits, you don’t have to worry about signing up
• Covers most of your inpatient and outpatient care
• You can combine Original Medicare with Medigap (Medicare Supplement plan) to get more coverage

Original Medicare – Cons

• Doesn’t cover dental, vision, or hearing
• Doesn’t provide prescription drug coverage

Medicare Advantage – Pros

• Covers most of your inpatient and outpatient care
• Most plans offer some dental, vision, and hearing coverage
• Most plans provide prescription drug coverage
• Offers you greater variety so that you can pick the best plan for your needs

Medicare Advantage – Cons

• You may have to pay more in out-of-pocket expenses and copayments
• Many plans require you to work with a set network of doctors and healthcare providers
• You’ll probably spend more on healthcare than you would with Original Medicare + Medigap

What Is the Best Plan for You?

Ultimately, the best plan for you will depend on your budget, your health, and your personal preferences. Original Medicare is perfect for people who don’t want to shop around for insurance. With Social Security benefits, you’re automatically signed up, and the service is the same for everyone. If you’re worried about prescription drugs or other costs that aren’t covered under Original Medicare, you still have the option of adding a Medigap plan to your policy.

On the other hand, Medicare Advantage is great for people who like to have a little more freedom to choose their insurance. It also has the added bonus of prescription drug coverage and a myriad of additional services. While it may cost you a bit more, it can be convenient to keep all of your health insurance in one simple plan.

Bottom Line

When it comes down to it, the benefits of Original Medicare vs. Medicare Advantage are pretty clear. They are simply two different sides of the same coin. In either case, you can rest easy knowing that you have affordable healthcare right at your fingertips.

If you’d like to learn more about Original Medicare and Medicare Advantage options, feel free to fill out the form or give us a call anytime. Our licensed agents are focused on giving you the information you need, with zero pressure to enroll in a plan.