Original Medicare vs. Medicare Advantage | How Are They Different?

• by Christian Worstell
• December 23, 2022
• Reviewed by John Krahnert

Original Medicare (Medicare Part A and Part B) is the federal health insurance program for people age 65 and older and people younger than 65 who have a qualifying disability or certain medical conditions.

Medicare Advantage plans (Medicare Part C) are sold by private insurers as an alternative to Original Medicare and provide at least the same benefits as Medicare Part A and Part B combined into one plan.

Coverage

The chart below provides a side-by-side comparison of the features and benefits of Original Medicare vs. Medicare Advantage.

Every Medicare Advantage plan must provide the same hospital and medical benefits as Medicare Part A and Part B, which includes:

• Hospital care
• Skilled nursing facility care
• Hospice
• Doctor’s services
• Durable medical equipment
• Mental health services

Many Medicare Advantage plans may offer some benefits that Original Medicare doesn’t cover, such as:

• Prescription drug coverage
• Dental coverage
• Vision coverage
• Hearing coverage
• Health and wellness program benefits, such as SilverSneakers

Medicare Advantage plans also have an annual out-of-pocket maximum, which limits how much you have to pay out of pocket for health care expenses in a single year. Original Medicare does not have an out-of-pocket maximum.

Costs

Whether you choose Original Medicare or Medicare Advantage, there are some out-of-pocket costs you must pay, including premiums, deductibles and coinsurance or copayments.

Premiums

Most people do not pay a premium for Medicare Part A, as long as they paid sufficient Medicare taxes while working. If you do have to pay a Part A premium, you could pay up to $499 a month in 2022.

The 2022 standard Medicare Part B premium is $170.10 per month.

Some Medicare Advantage plans feature $0 monthly premiums, and there may be $0 premium plans available where you live.

If you enroll in a Medicare Advantage plan that has a premium, you’ll pay your Medicare Advantage premium in addition to your Part B premium. If your Medicare Advantage plan does not have a premium, you’ll only pay your Part B premium.

Deductibles

In 2022, the Medicare Part A deductible is $1,556 per benefit period, and the Part B deductible is $233 per year.

Medicare Advantage plan deductibles vary depending on the specific plan you enroll in.  

Coinsurance

If you’re enrolled in Original Medicare you typically pay a 20 percent Part B coinsurance for covered services after you meet your Part B deductible, and Medicare pays the remaining 80 percent.

For inpatient hospital stays in 2022, you first have to meet your Part A deductible for the benefit period. After that, you pay $0 coinsurance for days 1-60, $389 per day for days 61-90 and $778 per day for each lifetime reserve day after day 90. After your lifetime reserve days are used, you are responsible for paying all costs.

Medicare Advantage plan coinsurance amounts vary depending on the specific plan you enroll in.

Enrolling in Original Medicare

Before you can enroll in a Medicare Advantage plan, you must enroll in Original Medicare.

Some people are automatically enrolled in Original Medicare three months before their 65th birthday, and some people must manually sign up for Medicare.

You will typically be automatically enrolled in Original Medicare if one or more of the following applies to you:

• You get benefits from Social Security or the Railroad Retirement Board at least four months before you turn 65
• You’ve been getting disability benefits for at least 24 months
• You have ALS (Lou Gehrig’s disease) and receive disability benefits

If you aren’t automatically enrolled in Original Medicare, you can manually enroll by:

• Visiting your local Social Security office
• Calling Social Security at 1-800-772-1213 (TTY users 1-800-0778), Monday through Friday 7AM-7PM
• Going to the Social Security website at www.SocialSecurity.gov

Enroll in a Medicare Advantage plan today

Once you’re enrolled in Original Medicare, you can sign up for a Medicare Advantage plan.

Compare Medicare Advantage plans that may be available in your area and speak with a licensed insurance agent who can help you sign up for a Medicare Advantage plan that’s right for you.

Or call 1-800-557-6059 1-800-557-6059 TTY Users: 711 to speak with a licensed insurance agent. We accept calls 24/7!

About the author

Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.

Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.

Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.

Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.

A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.

If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.

 

 

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