People with Medicare can get their health coverage through either Original Medicare or a 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.
- Original Medicare: The traditional program offered directly through the federal government
- Includes Part A (inpatient/hospital coverage) and Part B (outpatient/medical coverage)
- Most doctors in the country take this insurance
- Medicare limits how much an individual can be charged when they visit participating or non-participating providers
- Beneficiary receives a red, white, and blue card to show to providers when receiving care
- Medicare Advantage: Private plans that contract with the federal government to provide Medicare benefits
- Must provide the same benefits offered by Original Medicare, but may apply different rules, costs, and restrictions
- May also offer certain benefits that Original Medicare does not cover
- Some of the most common types of plans are Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and Private Fee-For-Service (PFFS) plans
- Beneficiary shows the membership card from their plan when receiving care
If you sign up for Original Medicare and later decide you would like to try a Medicare Advantage Plan–or vice versa–be aware that there are only certain enrollment periods when you are allowed to make changes.
Note: Keep in mind that different areas have different Medicare Advantage Plans. A particular plan may not be available where you live. Call 1-800-MEDICARE or your State Health Insurance Assistance Program (SHIP) to find out about plans available in your area.
The table below compares Original Medicare and Medicare Advantage. Remember that there are several different types of Medicare Advantage Plan. If you are interested in joining a plan, speak to a plan representative for more information.
|Original Medicare||Medicare Advantage|
|Costs||You will be charged for standardized Part A and Part B costs, including monthly Part B premium. Responsible for paying a 20% coinsurance for Medicare-covered services if you see a participating provider and after meeting your deductible.||Your cost-sharing varies depending on plan. Usually pay a copayment for in-network care. Plans may charge a monthly premium in addition to Part B premium.|
|Supplemental insurance||Have the choice to pay an additional premium for a Medigap policy to cover Medicare cost-sharing.||Cannot purchase a Medigap policy.|
|Provider access||Can see any provider and use any facility that accepts Medicare (participating and non-participating).||Typically can only see in-network providers.|
|Referrals||Do not need referrals for specialists.||Typically need referrals for specialists.|
|Drug coverage||Must sign up for a stand-alone prescription drug plan.||In most cases, plan provides prescription drug coverage (you may be required to pay a higher premium).|
|Other benefits||Does not cover vision, hearing, or dental services.||May cover additional services, including vision, hearing, and/or dental (additional benefits may increase your premium and/or other out-of-pocket costs).|
|Out-of-pocket limit||No out-of-pocket limit.||Annual out-of-pocket limit. Plan pays the full cost of your care after you reach the limit.|