Healthcare can take up a big part of your budget in retirement. That’s why Medicare exists—to help older adults manage healthcare costs. But Medicare can be confusing, especially when you hear terms like Original Medicare and Medicare Advantage.
They might sound similar, but there are some key differences that can affect your coverage, costs, and even which doctors you can see. Understanding how each one works can help you make the choice that best fits your lifestyle and healthcare needs.
What Is Medicare?
Medicare is a federal health insurance program for:
- People age 65 and older
- Some younger people with disabilities
- People with end-stage renal disease
There are two main ways to get Medicare: Original Medicare (Traditional Medicare) and Medicare Advantage (Part C).
What Is Original Medicare?
Original Medicare is the traditional program run by the federal government. It is made up of two parts—Part A and Part B.
Part A is your hospital insurance.
Covers:
- Hospital stays
- Skilled nursing facility care
- Hospice care
- Some home health care
Costs: While it covers a big portion of these costs, it’s not completely free. There is a deductible you have to meet, and if you’re in the hospital for more than 60 days, coinsurance kicks in.
Part B is your medical insurance.
Covers:
- Doctor visits
- Outpatient care
- Mental health services
- Preventive services (like screenings and vaccines)
- Ambulance services
Costs: For Part B, you pay a monthly premium. The exact amount depends on your income, so some people may pay more than others.
What Original Medicare Doesn’t Cover
Original Medicare does not include:
- Long-term care
- Most dental care
- Vision care and eyeglasses
- Hearing aids
- Cosmetic surgery
- Prescription drugs (you’ll need to purchase a separate Part D plan for that)
Some people also choose to buy a Medigap policy, which helps cover costs that Original Medicare doesn’t, like copayments and coinsurance. This can make care more affordable, but it means having multiple separate plans.
What Is Medicare Advantage?
Medicare Advantage, also called Part C, works differently. Instead of getting your coverage directly from the government, you sign up with a private insurance company that has been approved by Medicare. Think of it as an “all-in-one” alternative to Original Medicare.
Most Medicare Advantage plans include:
- Part A (hospital insurance)
- Part B (medical insurance)
- Part D (prescription drug coverage)
- Extra benefits like vision, dental, hearing, fitness programs, and even transportation to appointments
Costs vary depending on the insurance company and plan. Most plans require you to use doctors and hospitals in the plan’s network.
Key Differences Between Original Medicare and Medicare Advantage
To make it easier to compare, here’s a quick recap of the main differences between Original Medicare and Medicare Advantage.
Coverage
- Original Medicare: Nationwide coverage, but no extras like dental or vision.
- Medicare Advantage: Includes extra benefits but is usually limited to a provider network.
Prescription Drugs
- Original Medicare: Must add Part D separately.
- Medicare Advantage: Often included.
Out-of-Pocket Costs
- Original Medicare: No yearly limit on what you pay.
- Medicare Advantage: Has an annual cap on out-of-pocket costs. Once you reach the limit, the plan covers 100% of covered services.
Costs
- Original Medicare: You pay Part B premiums (and Part D if you add it). You can also buy a Medigap policy for extra coverage.
- Medicare Advantage: You still pay your Part B premium, but many plans have low or even $0 monthly premiums.
Which Option Is Right for You?
Choosing between Original Medicare and Medicare Advantage is a personal decision. It depends on your health needs, your budget, and how much flexibility you want in choosing doctors. If you travel frequently or want the widest choice of providers, Original Medicare may be the better fit. But keep in mind that you’ll likely need to add prescription drug coverage and may want a Medigap plan to cover extra costs.
If you’d rather have everything bundled into one plan with added benefits like dental and vision, Medicare Advantage might be the right choice. Just be sure to check that your doctors are in network and that the plan fits your budget and lifestyle.
Ensure You Have the Coverage You Need This AEP
Both Original Medicare and Medicare Advantage provide valuable coverage. Original Medicare offers flexibility and nationwide coverage, while Medicare Advantage simplifies your coverage and may save you money with added benefits.
The right plan can give you peace of mind and help you get the care you need without breaking the bank. Review your options during the Medicare Annual Enrollment Period. Look at your healthcare needs, the doctors you want to keep, and how much you’re willing to spend out of pocket.
Need Help Deciding?
If you already have an insurance broker or agent, now’s a great time to reach out and talk through your options.
You can also explore Medicare plans directly at www.medicare.gov or by calling 1-800-MEDICARE.
But don’t wait—enrollment ends December 7th. Missing the deadline could mean being locked into a plan that doesn’t fit your needs for another year.
