How Are MA Plans Different From Original Medicare?

October 06, 2024•3 min read

Understanding Original Medicare and Medicare Advantage

When it comes to Medicare, there are two primary options: Original Medicare and Medicare Advantage Plans. Understanding the differences between these two can help you make an informed choice that suits your healthcare needs.

What is Original Medicare?

Original Medicare is the traditional program offered directly through the federal government. It includes:

Part A (Hospital Insurance): Covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
Part B (Medical Insurance): Covers certain doctors' services, outpatient care, medical supplies, and preventive services.

Original Medicare does not include prescription drug coverage (Part D), dental care, or vision care. Beneficiaries often need a separate prescription drug plan and may consider a Medicare Supplement (Medigap) policy to cover out-of-pocket costs like deductibles, coinsurance, and copays.

What is a Medicare Advantage Plan?

Medicare Advantage Plans, also known as Part C, are offered by private insurance companies approved by Medicare. These plans provide all Part A and Part B benefits, and many offer additional benefits such as:

Prescription drug coverage
Dental care
Vision care
Wellness programs

Medicare Advantage Plans often have lower out-of-pocket costs than Original Medicare and may include additional benefits. However, they may require you to use a network of doctors and hospitals.

The Difference Between Original Medicare and Medicare Advantage

There are several key differences to consider when comparing Original Medicare and Medicare Advantage Plans:

Coverage: Original Medicare covers most medically necessary services but does not include prescription drug coverage. Medicare Advantage Plans often include additional benefits like prescription drug coverage and dental care.
Cost: Original Medicare requires you to pay a monthly premium for Part B, and you may need a separate prescription drug plan. Medicare Advantage Plans typically have one monthly premium that may be lower than the combined costs of Original Medicare and a separate drug plan.
Network: Original Medicare allows you to see any doctor or hospital that accepts Medicare. Medicare Advantage Plans usually require you to use a network of providers.
Out-of-pocket costs: Medicare Advantage Plans can have lower out-of-pocket costs, but they may also have more restrictions on the providers you can see.

Factors to Consider When Choosing Between Original Medicare and a Medicare Advantage Plan

When deciding between Original Medicare and a Medicare Advantage Plan, consider the following factors:

Healthcare Needs: If you require frequent medical services or have specific healthcare needs, a Medicare Advantage Plan with additional benefits might be more suitable.
Costs: Compare the monthly premiums, deductibles, and out-of-pocket costs of both options. Consider whether a Medicare Supplement plan is necessary if you choose Original Medicare.
Provider Network: If you have preferred doctors and hospitals, check if they are included in the Medicare Advantage Plan's network.
Extra Benefits: Evaluate the additional benefits offered by Medicare Advantage Plans, such as prescription drug coverage, dental care, and wellness programs.

Key Points to Remember

In summary, here are the key points to remember:

Original Medicare includes Part A and Part B but does not cover prescription drugs.
Medicare Advantage Plans (Part C) offer all the benefits of Original Medicare plus additional services.
Consider your healthcare needs, costs, and provider preferences when choosing between Original Medicare and a Medicare Advantage Plan.