Medicare Advantage Plans vs Original Medicare
Original Medicare is Part A hospital insurance and Part B medical insurance, while Medicare Advantage (Part C) plans are sold by private insurance companies and combine Part A and Part B benefits into a single plan. Learn more about the differences between Original Medicare and Medicare Advantage.
Medicare Advantage plans are a type of private insurance that cover the same benefits as Original Medicare (Part A and Part B) and may cover extra benefits Original Medicare doesn't cover.
There are advantages and disadvantages to Medicare Part C, also known as Medicare Advantage plans, with some drawbacks that may not make them suitable for everyone.
In this guide, we'll outline the pros and cons of Medicare Advantage vs. Original Medicare. By understanding these advantages and disadvantages, you'll be better equipped to make an educated decision about which option is right for you.
Advantages of Medicare Advantage Plans
Medicare Advantage plans combine the benefits of Medicare Part A and Part B, and plans may offer additional benefits not covered by Original Medicare.
One advantage of Part C is that many Medicare Advantage plans include additional benefits not found in Original Medicare. These benefits aren't available with all plans, however, so it's important to compare your local options to see what's offered where you live.
- Dental, vision and hearing
According to the Kaiser Family Foundation, many 2023 Medicare Advantage plans (99%) covered vision benefits, and 97% of plans covered dental and hearing benefits.1 Original Medicare does not typically cover routine vision, hearing or dental benefits.
- Prescription drugs
The vast majority of 2023 Medicare Advantage plans (89%) covered prescription drugs, and in 2023, two-thirds (66%) of these plans charged no monthly premium.1 $0 premium Medicare Advantage plans aren't available in all locations, and you're still required to pay your monthly Part B premium.
- Fitness and wellness
Some Medicare Advantage plans offer gym memberships or fitness programs, promoting an active and healthy lifestyle. According to the Kaiser Family Foundation, 99% of plans offered such benefits in 2023, which are benefits not offered by traditional Medicare.
Enrolling in a Medicare Advantage plan can allow you to manage your health care under one umbrella policy instead of juggling multiple insurance cards. This convenience can make it easier for beneficiaries to manage their healthcare expenses and stay on top of their medical appointments.
Disadvantages of Medicare Advantage Plans vs. Original Medicare
One potential disadvantage of Medicare Advantage plans is the provider network limitations that a plan may include.
Unlike Original Medicare, which allows beneficiaries to see any doctor or specialist who accepts Medicare, some types of Medicare Advantage plans may have a select group of providers you can visit for covered services.
Two common types of Medicare Advantage plans include:
- Health maintenance organizations (HMO)
- Preferred provider organizations (PPO)
These types of networks may restrict your choice of healthcare providers of covered services and may require pre-authorization for certain services.
Many under-65 health insurance plans use an HMO or PPO structure, however, so you may be somewhat used to provider networks.
A licensed insurance agent can help you compare Medicare plans available where you live, including whether plans are accepted by your favorite doctors and specialists.
Comparing Original Medicare vs Medicare Advantage Plans
Some of the differences of Original Medicare vs. Medicare Advantage can be summarized as differences in coverage, costs and flexibility.
- Coverage: Both options offer inpatient Part A coverage and Part B medical insurance. However, Medicare Advantage plans may include additional benefits that are not available with Original Medicare.
- Costs: Medicare Advantage plan monthly premiums, copays, deductibles and other costs can vary significantly depending on the plan chosen. Original Medicare premiums, coinsurance and other costs are set by the Centers for Medicare & Medicaid Services (CMS) each year. Medicare Advantage plans are required to offer an annual maximum out-of-pocket spending limit that Original Medicare doesn't offer.
- Flexibility: With a Medicare Advantage plan, you may be required to use a select group of providers within your network to receive covered services. With Original Medicare, you can visit any doctors or hospitals nationwide who accept Medicare patients.
Ultimately, the choice between Original Medicare and a Medicare Advantage plan depends on your individual healthcare needs, preferences and budget.
What percent of beneficiaries choose Medicare Advantage?
Over half of eligible beneficiaries opt for a Medicare Advantage plan, and the percentage has been steadily increasing over recent years due to expanded offerings and competitive pricing.1
To learn more and to compare plan information for the options offered where you live, request a free plan quote online or call to speak with a licensed insurance agent.
We represent carriers such as Humana, UnitedHealthcare®, Anthem Blue Cross and Blue Shield, Aetna, Cigna Healthcare, Wellcare, or Kaiser Permanente.
1 Ochieng N, et al. (Aug 9, 2023). Medicare Advantage in 2023: Enrollment Update and Key Trends. Kaiser Family Foundation. https://www.kff.org/medicare/issue-brief/medicare-advantage-in-2023-enrollment-update-and-key-trends.