Medicare vs. Medicare Advantage: Know the Difference?

There are two ways to access Medicare coverage: Original Medicare and Medicare Medicare advantageAdvantage Plans.

Currently, 58 million people in the United States are enrolled in Medicare — of which 19 million are enrolled in Medicare Advantage Plans.

Obviously there is a great confusion about all things Medicare.  With the end of Medicare open-enrollment coming up on December 7th, we wanted to take this time to explain your Medicare options.

For more information about Medicare basics, read our Quick Guide to Medicare or watch our Medicare webinar.

If you aren’t familiar with Medicare Advantage plans, you are not alone.

  • 65% of seniors on Medicare are unfamiliar with Medicare Advantage
  • 49% percent of those enrolled in Medigap plans say the option of Medicare Advantage was not made clear to them when researching Medicare coverage options
  • 55% of those enrolled in Original Medicare say they either do not understand or do not know the difference between being enrolled in Original Medicare and Medicare Advantage only
  • 20% of those enrolled in Medicare Advantage report not knowing the difference between Original Medicare and Medicare Advantage.
  • 59% across plan type do not understand or do not know the differences between Advantage and Medigap plans

In Original Medicare, the government pays for your health care benefits.  In a Medicare Advantage plan, your health care benefits are paid through a private insurance company that has been approved by Medicare.  Medicare Advantage plans come in many plan types, but the two common types are HMOs and PPOs. And, they work just like private insurance HMOs and PPOs. There is a network of doctors that accept the plan, and your costs are lower if you go to an in-network doctor. In Original Medicare, you can see any providers that accept Medicare.

Medicare Advantage plans combine your Part A (hospital benefit), Part B (health insurance benefit) and sometimes Part D (prescription drug benefit) all in one convenient plan.  In addition to those benefits, Advantage Plans often offer coverage that goes beyond Original Medicare, such as:

  • Routine eye exams, prescription eyewear, and/or contact lenses
  • Hearing exams; some may include an annual benefit toward hearing aids
  • Routine dental exams and non-surgical restorations
  • Wellness and fitness programs (some even include discounted gym memberships)

The cost of a Medicare Advantage plan will vary based on the plan you choose, the insurance company that is offering the plan, and where you live.  You may pay your monthly Part B premium plus a possible additional premium charged by the Medicare Advantage plan.  Keep in mind that premiums, co-payments, and benefits can change from year to year, and vary greatly from plan to plan, and company to company.  Read the fine print carefully, especially concerning prescription drug coverage. One benefit to Medicare Advantage is that some plans offer an out-of-pocket maximum, capping the medical expenses that you pay out-of-pocket during the year.  Original Medicare does not have an out-of-pocket maximum.

If you choose to go with a Medicare Advantage plan, you need to understand that this plan replaces Original Medicare, it does not supplement it.  You can also not use Medigap plans (supplemental Medicare) with a Medicare Advantage plan. That said, having a Medicare Advantage means you are in the Medicare Program and under the same protections that all Medicare recipients receive.  Your plan will last an entire year, at which point you can change plans or revert back to Original Medicare.

For more information about Medicare Advantage Plans, visit:

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