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

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.

Senior couple walking in forest

Coverage

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

Original Medicare vs Medicare Advantage

Feature/Benefit

Original Medicare

Medicare Advantage

Helps cover hospital and medical costs

May cover routine dental care

May cover routine vision care

Usually covers prescription drugs

Has an out of pocket maximum

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:

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 $437 a month in 2019.

The 2019 standard Medicare Part B premium is $135.50 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 2019, the Medicare Part A deductible is $1,364 per benefit period, and the Part B deductible is $185 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 2019, you first have to meet your Part A deductible for the benefit period. After that, you pay $0 coinsurance for days 1-60, $341 per day for das 61-90 and $682 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.

Call TTY Users: 711 24 hours a day, 7 days a week to get started with an agent.

 

Most people who are enrolled in Original Medicare are eligible for Medicare Advantage. However, most Medicare Advantage plans are not available to people with End Stage Renal Disease (ESRD).

If you have ESRD and would like a Medicare Advantage plan, contact an insurance agent to learn more about Medicare Special Needs Plans (SNPs) that may be available where you live.

Copyright 2018 TZ Insurance Solutions LLC. All rights reserved.

MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts; enrollment in any plan depends upon contract renewal.

Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

Medicare has neither reviewed nor endorsed this information.