How Are MA Plans Different from Original Medicare

Revised on October 1, 2024

Understanding Original Medicare

Original Medicare includes two main parts: Part A and Part B. Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Part B covers certain doctors’ services, outpatient care, medical supplies, and preventive services. Original Medicare is a federal program that provides healthcare to individuals aged 65 and older, or those who qualify due to a disability.

Original Medicare and Medicare Advantage

Medicare Advantage, also known as Part C, is an alternative to Original Medicare. These plans are offered by private insurance companies that contract with Medicare. Medicare Advantage Plans must offer the same benefits as Original Medicare, but they can also provide additional benefits such as dental, vision, and hearing services. Many Medicare Advantage Plans include prescription drug coverage, known as Part D.

The Difference Between Original Medicare and Medicare Advantage Plan

The primary difference between Original Medicare and Medicare Advantage Plans is how you receive your benefits. Original Medicare allows you to go to any doctor or hospital that accepts Medicare, while Medicare Advantage Plans typically have networks of providers. Here are some key differences:

• Coverage: Original Medicare covers Part A and Part B services. Medicare Advantage Plans cover Part A and Part B services and often include additional benefits like dental and vision.
• Costs: With Original Medicare, you pay a monthly Part B premium, a deductible, and coinsurance. Medicare Advantage Plans may have different cost structures, including copays and a different premium.
• Prescription Drugs: Original Medicare does not include prescription drug coverage (Part D), while many Medicare Advantage Plans do.

Comparing Original Medicare to Medicare Advantage

When comparing Original Medicare to Medicare Advantage, think about the following factors:

• Provider Choice: Original Medicare allows you to see any doctor or hospital that accepts Medicare. Medicare Advantage Plans may have a network of providers you must use.
• Additional Benefits: Medicare Advantage Plans often provide extra benefits, such as dental and vision coverage, that Original Medicare does not.
• Out-of-Pocket Costs: Original Medicare includes out-of-pocket costs like deductibles and coinsurance. Medicare Advantage Plans may have different structures for these costs.

Medicare Advantage Plans Cover More

Medicare Advantage Plans generally cover all the services that Original Medicare covers, but they may also offer additional benefits such as:

• Prescription Drug Coverage (Part D)
• Dental and Vision Services
• Wellness Programs

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

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

• Healthcare Needs: Evaluate your current and future medical care needs.
• Provider Flexibility: Consider whether you want the flexibility to see any provider that accepts Medicare or if you are comfortable with a network of providers.
• Additional Benefits: Think about whether you need extra benefits like dental or vision coverage.
• Cost: Compare the costs of premiums, deductibles, and out-of-pocket expenses.

Switching from Original Medicare to Medicare Advantage

If you are enrolled in Original Medicare and are considering switching to a Medicare Advantage Plan, here are some steps to follow:

• Review the Medicare Advantage Plans available in your area.
• Compare the benefits, costs, and provider networks of each plan.
• Check if your current doctors are in the plan’s network.

We’re Here to Help

Making the right choice between Original Medicare and Medicare Advantage can be challenging. BoomerBaby is here to help! Contact us at 1 (800) 903-8044 for personalized assistance and to learn more about your options. We have locations in Mill Valley, California; Bend, Oregon; Santa Ana, California; Sun Valley, Idaho; and Boulder, Colorado.