August 2022: Choosing Between Original Medicare and Medicare Advantage

Choosing Between Original Medicare and Medicare Advantage

People with Medicare can get their health coverage through either Original Medicare or a Medicare Advantage Plan. Here a look at the differences between the two options:

Original Medicare: The traditional program offered directly through the federal government.

Original Medicare includes Part A (inpatient/hospital coverage) and Part B (outpatient/medical coverage). You will receive a red, white, and blue card to show to your providers when receiving care. Most doctors in the country take your insurance. Medicare limits how much you can be charged if you visit providers who accept Original Medicare.

Medicare Advantage:  Private plans that contract with the federal government to provide Medicare benefits.

Medicare Advantage (MA) Plans are also known as Medicare private health plans or Part C. Instead of the red, white, and blue Original Medicare card, you will show the membership card from your plan to your providers. Plans must provide the same benefits offered by Original Medicare, but they may apply different rules, costs, and restrictions, such as provider networks or referral requirements. They also may offer certain benefits that Medicare does not cover.

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 certain enrollment periods when you are allowed to make these changes.

The table below compares Original Medicare and Medicare Advantage. Remember that there are several different kinds of Medicare Advantage Plans. If you are interested in joining a plan, speak to an American Senior Resources Medicare Specialist about your options or contact your own advisor, visit or specific plan representative for more information.

Original Medicare Medicare Advantage
Costs Standardized Part A and B costs, including monthly Part B premiums and 20% coinsurance for Medicare-covered services if seeing a participating provider (after meeting your deductible). Varies depending on plan. Usually a copayment is owed for in-network care. Plans may charge a monthly premium in addition to the Part B premium.
Supplemental Insurance Have the choice to pay an additional premium for a Medigap to cover Medicare cost-sharing. Cannot enroll in a Medigap plan.
Provider access Can see any provider and use any facility that accepts Medicare (participating or non-participating) Typically can see only in-network providers.
Referrals Do not need referrals for specialists. Typically need referrals for specialists.
Drug coverage Must sign up for a stand-along prescription drug plan. In most cases, plan provides prescription drug coverage (you may charge 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 ($7,550 for most plans in 2022).