Original Medicare Vs. Medicare Advantage

By: Agnus Smith
Published: Wednesday, July 25 2018
Last Updated: 4 years ago

When you sign up for Medicare, you are enrolled in both Parts A and B. All members have the option to sign up for a Medicare Advantage plan, and they have the ability to drop their Medicare Advantage plan and revert back to Original Medicare during certain times of the year.

However, there are some differences between Original Medicare and Medicare Advantage which are important to understanding The benefits of each are determined by your personal situation, the medications you take, and the health coverage you require to maintain your health.

Here, we will brief you on the differences between the two, but only you can decide what is best for you based on your own needs. If you are curious about the differences between Original Medicare vs. Medicare advantage, the information you find here will help you make a decision.

The Difference Between Original Medicare And Medicare Advantage

Most people are familiar with Original Medicare. They know that it is a form of health care coverage they receive when they turn 65, as long as they have met the enrollment requirements. However, not a lot of people know the difference between Original Medicare and Medicare Advantage. We will cover the differences here, and explain a little bit about both types of insurance.

Original Medicare

Original Medicare, also known as Parts A and B, are managed by the federal government, more specifically, the Centers for Medicare and Medicaid Services (CMS). This insurance provides coverage for hospitalization, doctor visits, and services from health care providers who accept their insurance plans.

Essentially, the health coverage is based on a fee-for-service basis. CMS decides how much they are willing to pay providers for each given service. Any amount above the approved fee-for-service is paid by the insurance recipient. But how does the service work and what do they cover?

Traditional Medicare does not cover prescription medications, but you can purchase a separate Part D prescription plan during certain times of the year. They do not cover out of country medical costs, even if you obtained your policy while in the United States. Members who require long-term hospitalization or a stay in a skilled nursing facility will only receive a pre-approved number of care days. Anything after this point will need to be paid for by the member on an out-of-pocket basis.

If you require more coverage than is traditionally provided Original Medicare vs. Medicare Advantage will be an interesting read for you. When comparing Original Medicare vs. Medicare Advantage you will see that there are additional coverage options available, and they may be more affordable than you think.

Medicare Advantage

If you have never heard of an Advantage plan, but you are interested in additional coverage that Medicare does not provide, you will be happy to hear about them. This option was released in 1995 as an additional method of coverage for people who were on Medicare. It was developed by the federal government and was designed to allow traditional health insurance companies to sell plans that were designated as Medicare Advantage plans.

These plans are required to provide the minimum benefits options of traditional Medicare services. However, they are allowed to offer additional services in exchange for monthly premiums. Most Medicare Advantage Plans cover a number of services that Original Medicare does not. They cover things like your Dental visits, vision, prescription medications, and additional medical and hospital costs that are not covered by a traditional plan.

Medicare Advantage does have a maximum out-of-pocket financial cap that is not provided with traditional plans. After you have paid a given amount out of pocket, the plan will provide 100% coverage for the remaining portion of the year on most services. This information may have you considering a switch from Original Medicare to Medicare Advantage.

Before you make a decision, let's look at the pros and cons of making the switch from Original Medicare to Medicare Advantage.

Pros And Cons Of Advantage Vs. Original

When you are comparing Original Medicare vs. Medicare Advantage, you will see that there are additional services available to you as a recipient of Medicare. There are a number of positives in upgrading your plan, but there are a few downfalls as well. You can purchase advantage plans with a number of benefits and in a number of styles.

You can choose between Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Private Fee-for-Service (PFFS), Special Needs Plans (SNPs), HMO Point-Of-Service (HMOPOS), Medical Savings Account (MSA). Each of these types of plans will cover specific things and will provide less coverage in some areas. Make sure to research them completely before deciding what is best for you.

Which Is Better?

Unfortunately, no one can decide what coverage is right for you. If you are trying to determine how the differences between Original Medicare vs. Medicare Advantage affect you, an insurance broker may be able to help. Each individual must evaluate their own health care needs, and compare policies that are best for them.

Take time to do your own research and compare your health care needs to what a policy provides. If you are uncertain about which policy to choose, consult an expert in health insurance coverage to help you weigh the options you have.

Can You Switch From Advantage to Original?

Certain times of the year allow you to reevaluate your point of view on Original Medicare vs. Medicare Advantage. You can switch from Original Medicare to Medicare Advantage, or switch back to Original Medicare from an Advantage plan.

The best time to make this change is during Open Enrollment, which is a time when all coverage changes should be made. Open enrollment is from October 15th through December 7th each year. Any changes made to your health coverage during this time become effective January 1.