Medicare Options

Medicare Advantage vs. Original Medicare​​​​

If you’re deciding between Original Medicare and Medicare Advantage, here are some key things to keep in mind:


​Cost

Your premium is the amount you pay for your health insurance coverage each month. Original Medicare and Medicare Advantage plans generally have different monthly premiums. In Original Medicare, you will pay a monthly Part B premium. You may also have to pay a Part A premium if you did not pay enough Medicare taxes while you were working. Many Medicare Advantage plans offer $0 or low premiums. These amounts will vary by plan and by geographic location, so be sure to check the specific plans available in your area.

​Coinsurance is the percentage you pay for a covered health service—it varies based on the total cost of the services you receive. Original Medicare usually requires a 20% coinsurance, so beneficiaries are responsible for paying 20% of the total bill. This can vary based on the amount of the final bill, which can make planning ahead a challenge. Medicare Advantage plans usually have set dollar amounts for most services and procedures, which allows their members to plan ahead.

​The maximum out-of-pocket is the most you are responsible for paying in a year. Copays for doctor visits and hospital stays count towards the maximum out-of-pocket. Most Medicare Advantage plans have a maximum out-of-pocket. Once you’ve reached this amount for the year, your insurance company pays for 100% of covered services. Original Medicare plans do not have a maximum out-of-pocket, so there’s no limit to how much you’ll have to spend in a calendar year.


​Coverage

Original Medicare plans only includes hospital and medical insurance, so if you need prescription drug coverage, you’ll need to purchase a separate Part D plan. Medicare Advantage plans usually combine all Part A and Part B services with Part D prescription drug coverage.

​If you have Original Medicare, you can go to any doctor that accepts Medicare. Most Medicare Advantage plans require you to see a doctor or facility in their network.


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