Original Medicare vs. Medicare Advantage

Medicare works with private health insurers to provide different ways to get your health care coverage in the Medicare program. These private plans are called Medicare Advantage. The choice of whether to stay in Original Medicare or enroll in a private Medicare Advantage plan affects many things like cost, benefits, doctor choice, convenience and quality. The information below will help you determine which is right for you: Original Medicare or Medicare Advantage.

Original Medicare

Under Original Medicare, you can use the specialists and hospitals of your choice—without a referral from another doctor. Medicare Advantage plans could limit your ability to get care from the doctor or hospital of your choice, or there may be extra charges for out-of-network care. So if provider choice is a priority, you should consider Original Medicare.

Original Medicare pays for many health care services and supplies, but it doesn't pay all of your health care costs. There are costs that you must pay, like coinsurance, co-payments, and deductibles. These costs are called "gaps" in Medicare coverage. You might want to consider buying a Medigap or Medicare Supplement policy to cover these gaps in Medicare coverage. You can also add prescription drug coverage by joining a Medicare Prescription Drug Plan.

Medicare Advantage

In most cases, Medicare Advantage offers benefits and lower co-payments than Original Medicare. However, with PPO and HMO plans you may have to see doctors that belong to the plan or go to certain hospitals to get services or risk higher out-of-pocket expenses for going "out-of-network". So, if you are on a tight budget and are willing to limit your choice of doctors and hospitals, you may be able to reduce your health care expenses and get additional benefits through a Medicare Advantage plan.

It is important to review the scope and limits of additional benefits when choosing among available plans. It is also important to look at how much your out-of-pocket costs will be if you get sick. For example, some Medicare Advantage plans charge a co-pay for each day of an inpatient hospital stay, while Original Medicare charges only a deductible but no daily co-pays for the first 60 days of a hospital stay.

Medicare Advantage Plans are available in many areas. If you have one of these plans, you don't need a Medigap policy. Some plans cover prescription drugs (these plans are known as, MA-PD for Medicare Advantage-Part D).