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Medicare Advantage vs. Medicare


When comparing Medicare Advantage vs. Medicare (Part A and Part B), you find that both options provide similar benefits. However, they are ultimately very different forms of coverage.

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One of the most important decisions you will make when Medicare-eligible is the type of Medicare coverage in which you enroll. Remember, there are multiple factors to consider when enrolling in a Medicare plan.

Thus, it can be easy to make the wrong choice – a choice that you may not be easily be able to change. In this article, we compare Medicare Advantage vs. Medicare, side-by-side, to better understand how each coverage type works.

What is the Difference Between Regular Medicare and a Medicare Advantage Plan?

Regular Medicare, formally referred to as Original Medicare, is made up of Medicare Part A and Medicare Part B. The federal government administers both parts of this coverage.

Medicare Part A covers hospital benefits, and Medicare Part B is your outpatient medical coverage. Seniors pay into Original Medicare by paying Medicare taxes throughout their working career.

On the other hand, with Medicare Advantage, private insurance companies manage your benefits, not the government. Medicare pays the carrier to administer your benefits under Medicare Part C (Medicare Advantage).

These private insurance companies must follow the guidelines the federal government sets. However, the companies can set their own prices, deductibles, and additional benefits.

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Pros and Cons of Medicare Advantage Plans vs. Original Medicare

Determining the best route for your needs means comparing the benefits each coverage type includes. Healthcare is different for everyone. Below is a breakdown comparison of Medicare Advantage vs. Medicare Part A and Part B.

Pros of Medicare Part A and Part B

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Every senior that enrolls in Original Medicare receives identical benefits. There are no networks, no copays, no waiting periods, and no pre-existing condition limitations. You can see any doctor that accepts Medicare, and any out-of-pocket costs remain the same, regardless of the provider from whom you receive care.

Additionally, your coverage will travel with you across the United States. So, if you live in California, your coverage remains the same if you travel to Ohio, New Jersey, or even Florida. Regardless of the state you are in, Original Medicare benefits do not change.

Cons of Medicare Part A and Part B

With Original Medicare, you are responsible for the Medicare Part B premium, Part A deductible, Part B deductible, and Part A and Part B coinsurances. With these costs, there is no out-of-pocket maximum for Original Medicare. Additionally, you will need to pay a monthly premium for Medicare Part A if you do not work enough quarters while paying Medicare taxes.

Alongside the out-of-pocket costs, another con is that Original Medicare does not provide additional benefits. These include dental, vision, hearing, and drug coverage. If you require this coverage, you will have to seek additional policies.

Pros of Medicare Advantage

Some Medicare Advantage plans offer zero-dollar premiums or a Medicare Part B give-back option. Additionally, all Medicare Advantage plans have a maximum out-of-pocket limit. This means the plan will completely cover your medical costs after you meet a certain out-of-pocket threshold.

Medicare Advantage plans can also come with additional perks like dental, vision, and hearing benefits. Some plans may even include gym memberships, as well as long-term care benefits. Lastly, most Medicare Part C plans include coverage for prescription medications.

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Cons of Medicare Advantage

Medicare Advantage benefits vary from plan to plan. Further, you still must pay your Medicare Part B premium.

Yet, the biggest downfall of Medicare Advantage is the limited provider networks. When you need to see a specialist with a small network, access to care can be more challenging.

Another con of Medicare Advantage plans is the high cost per service. While low to zero-dollar premiums are appealing, the out-of-pocket costs you pay as you use the benefits may lead you to conclude that your Medicare Advantage plan is just not worth it.

Unlike Medicare Part A and Part B, Medicare Advantage plans come with annual coverage changes. The plan that works for you now may not work for you next year. So, you must constantly be on top of your benefits to ensure you are on the right plan.

Additionally, Medicare Advantage plans also do not travel with you. Meaning, if you plan on traveling in your retirement, you will need to find other coverage options.

Lastly, although there is a maximum out-of-pocket limit, you can still pay thousands of dollars per year for your healthcare.

Which is Better: Original Medicare or Medicare Advantage?

Medicare Advantage plans must offer coverage at least to the standard of Medicare Part A and Part B. Yet, Original Medicare tends to have more flexibility.

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Most insurance agents agree that some coverage is better than none. So, this makes enrolling in a Medicare Advantage plan a tad better than only having Medicare Part A and Part B. Yet, not as good as enrolling in a Medicare Supplement, which pair with your Original Medicare coverage to extend benefits.

Keep in mind that you cannot have both a Medicare Advantage plan and a Medicare Supplement plan at the same time. So, you’ll need to decide which plan works best for your needs.

Medicare Advantage plans work for some individuals, but they do not work well for all seniors. They are a good option for those who cannot get a Medicare Supplement plan due to health or for those under 65 on disability.

Ultimately, the best choice for seniors comparing Medicare Part A and Part B vs. Medicare Advantage is dependent on the needs of the individual.

Is Medicare Advantage Cheaper Than Medicare Part A and Part B?

Medicare Advantage plans can cost less than Original Medicare if you expect to have high healthcare costs throughout the year. However, you still have to pay the Medicare Part B premium in addition to your Medicare Advantage premium, if your plan has one.

Medicare pays private insurance companies offering Medicare Advantage plans to manage your health care benefits. In addition, they collect money from enrollees in the form of cost-sharing as they use their benefits. This is how they can afford to have lower premiums.

However, the costs of healthcare services can be high. You should consider these costs and your health needs when determining the best coverage for you.

Original Medicare vs. Medicare Advantage: Covered Services

When you have Original Medicare, you can see any doctor or specialist that accepts Medicare nationwide. You do not need to obtain a referral to see a specialist. Plus, since plans do not change annually, you will not need to worry about your doctor leaving the plan’s network.

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When you have Medicare Advantage, your coverage will be very similar to your employer group coverage as most are health maintenance organizations (HMO) and preferred provider organizations (PPO).

Often, your Medicare Advantage plan will have a primary care physician that coordinates your care. Therefore, you need a referral to see a specialist.

Another note seniors should make is that physicians can leave the plan’s network at any time. You could find yourself searching for a new primary care physician at any point of the year without notice.

With Medicare Part A and Part B, you receive coverage for a wide range of medical services. These include diagnostic tests, durable medical equipment, outpatient surgery, hospitalization, preventive services, and much more. However, Original Medicare does not include coverage for routine dental care, vision, or hearing care.

With Medicare Advantage, you will have coverage for the same services as Original Medicare. In addition, you can receive coverage for some dental, vision, and hearing care, or even prescription drug coverage. The downside is you may have trouble finding a dentist, eye care practitioner, or audiologist that accepts your Medicare Advantage plan.
Medicare Coverage Options

Can I Drop My Medicare Advantage Plan and Go Back to Original Medicare?

There are two enrollment periods throughout the year that allow you to leave your Medicare Advantage plan and return to Original Medicare. You can make this change during the Annual Enrollment Period and the Medicare Advantage Open Enrollment Period.

Do You Have to Pay for Medicare Part B if You Have a Medicare Advantage Plan?

Yes, you still must pay your Medicare Part B premium if you have a Medicare Advantage plan. Some plans offer a Medicare Part B give-back benefit, but only in certain areas.

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How to Compare Medicare Advantage vs. Medicare Part A and Part B

Here at MedicareFAQ, we understand how overwhelming Medicare can be. That is why we dedicate our time to being your ultimate Medicare resource center. Instead of calling each company to find a quote, you can call us, and we will walk you through everything you need to know. Including rates from the top carriers in your area.

We can even help you sign up for the policy that makes the most sense for you. If you are unsure about which option provides you with the most value, contact one of our agents at the phone number above to compare Medicare Advantage vs. Medicare Part A and Part B. Or, you can fill out an online rate form to get your rates now.

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Sources:

MedicareFAQ is dedicated to providing you with authentic and trustworthy Medicare information. We have strict sourcing guidelines and work diligently to serve our readers with accurate and up-to-date content.

  1. Medicare Advantage Plans, Medicare. Accessed March 2022.
    https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/medicare-advantage-plans
  2. Medicare Advantage 2022, KFF. Accessed March 2022.
    https://www.kff.org/medicare/issue-brief/medicare-advantage-2022-spotlight-first-look/
  3. Original Medicare Enrollment and Eligibility, CMS. Accessed March 2022.
    https://www.cms.gov/medicare/eligibility-and-enrollment/origmedicarepartabeligenrol

Jagger Esch

Jagger Esch is the Medicare expert for MedicareFAQ and the founder, president, and CEO of Elite Insurance Partners and MedicareFAQ.com. Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. He is featured in many publications as well as writes regularly for other expert columns regarding Medicare.

4 thoughts on “Medicare Advantage vs. Medicare

  1. with the medicare advantage plan we have, we are allowed a sizeable amount for dental and some for vision. Is it cheaper to have straight medicare with medigap or medicare advantage?

    1. Hi Doris! The monthly premium will always be cheaper with a Medicare Advantage plan. They can afford to charge low to zero premiums since Medicare pays the carrier to take on your risk. However, where you end up paying more is in copays, deductibles, and coinsurance. The carrier chooses how much of each service they want to pay. The dental and vision benefits that come with Medicare Advantage plans are not extensive like they are with stand-alone DVH plans. With Medicare + Medigap, your monthly premiums will be more, but your cost-sharing is significantly lower. You won’t have to pay a copay each time you visit the doctor or any coinsurance. It just depends on when you want to spend the money, upfront in monthly premiums, or risk paying more in cost-sharing as you go.

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