Medicare Advantage vs. Original Medicare

When it comes to enrolling in Medicare, there are 2 main options: Original Medicare and Medicare Advantage. What’s the difference between them? What do they include?

We’ve included details below to help you understand the differences between these types of plans, so you can choose the right type of Medicare coverage to meet your needs.

Original Medicare vs. Medicare Advantage
  Original Medicare - Covers Part A & Part B
Coverage by the federal government		 Medicare Advantage - "All-in-one" plans
Coverage by private companies approved by the federal government
Services Covered

Covers hospital (Part A) and outpatient doctor and medical services (Part B) costs only.

Does NOT include prescription drug, dental, vision or hearing coverage or provide extra supplemental benefits.

Covers everything that Original Medicare covers (Parts A & B), plus more.

Many Medicare Advantage plans also include prescription drug, dental, vision and hearing coverage, and extra benefits like gym memberships, over-the-counter allowances and more.

Medicare Advantage plans are also referred to as Part C.
Premium
Monthly plan cost		 Part A monthly premium (2021): $ 471.00

Most people don’t pay a Part A premium due to paying Medicare taxes while working.

Part B monthly premium (2021): $ 148.50

Watch out for the Part B Late Enrollment Penalty—a penalty that applies if you don’t sign up for Part B when you’re first eligible or don’t meet other conditions for late enrollment. Learn more.

Many plans have low-cost premiums, with some plans even having $0 premiums.

*You must still pay the monthly Part B premium, in addition to your plan premium.
Deductibles
The amount of money you have to pay before your plan starts paying towards your costs

Part A deductible (2021): $ 1,484.00

Part B deductible (2021): $ 203.00

Many plans have $ 0 or low deductibles for medical services and generic prescription drugs.
Coverage & Cost of care

Covers 80% of approved healthcare costs after meeting your deductible; you are responsible for paying the other 20% of the approved amount for services.

Coverage and cost-sharing varies depending on plan. You usually pay a copayment to receive care.
Out-of-Pocket Maximums

No limit to what you pay out-of-pocket. Plus, Medicare only pays for a limited number of days in the hospital or skilled nursing facility.

Includes an out-of-pocket maximum each year. Once you pay a certain amount, the plan pays 100% of the cost for most covered services.
Drug Coverage

Also known as Part D.

Does NOT include drug coverage. A separate prescription drug plan is needed, at an additional cost.

Watch out for the Part D Late Enrollment Penalty—a penalty that applies if you don’t sign up for drug coverage or have other creditable drug coverage when you’re first eligible. Learn more.

Many Medicare Advantage (MA) plans include drug coverage, also known as part D. These are called MAPD plans.
Referrals

A referral is not required to see a specialist.

Many plans do not require a referral to see a specialist.
Network

You can see any provider or facility that accepts Medicare.

Some plans require you use providers and facilities in-network (i.e. HMO plans).

Some plans do not require you to use a specific network (i.e. PPO plans). With these plans, you can see any provider or facility that accepts Medicare.
Travel Coverage

Except in extremely rare cases, Medicare doesn't cover care received when you're out of the country, even in an emergency.

Most plans cover emergency care when you’re out of the country, including emergency care up to a lifetime maximum amount.

Remember, regardless of whether you choose Original Medicare or a Medicare Advantage plan, you’ll want to enroll in Medicare (Parts A &B) when you’re first eligible—sometime between the 3 months before and the 3 months after you turn 65—to avoid paying penalties later. Learn more about penalties here. 

Learn more about Medicare and MyTruAdvantage—Indiana’s own community-focused Medicare Advantage plan. MyTruAdvantage is a Medicare Advantage plan founded by doctors and hospitals you know and trust, focused on the community and designed around you.