Medicare Advantage vs Medicare discover the differences. For example, Medicare Advantage charges copays for each doctor visit or medical service. However, Original Medicare only charges copays for specific diagnostic tests, hospital outpatient, and ER visits. For all other doctor visits and services, Original Medicare may charge 20% coinsurance.
Original Medicare only covers 80% of Medicare-approved expenses. Thus, you pay 20% coinsurance for most health services. In comparison, Medicare Advantage plans have no coinsurance costs.
The 2021 chart below compares the differences between Original Medicare vs. Medicare Advantage. Original Medicare provides you with nationwide coverage and access to more doctors and hospitals without referrals. In comparison, Medicare Advantage provides you with local or regional coverage for doctors and hospitals in-network. You can see several differences between Medicare Advantage vs. Original Medicare in the chart below.
To enroll in Medicare Advantage (MA) plan, you must have Medicare Part B and pay the monthly premium. In 2021, the standard Medicare Part B premium is $148.50. However, beneficiaries who earned more in 2019 than $88,000 individually or $176,000 jointly may pay higher Part B premiums.
Furthermore, you may have to pay additional Advantage Plans premiums. According to KFF.org, among those who pay MA premiums, the average is $60 per month in 2021.
A significant difference between Medicare Advantage vs. Original Medicare is prescription drugs. Most Advantage Plans include prescription drug coverage. For example, HMO plans often have a drug plan, while PPO and PFFS plans may cover prescription drugs.
In comparison, Original Medicare does not cover prescription drugs. Original Medicare requires you to enroll in a separate Part D drug plan to get prescription drug coverage. The last difference is the max out-of-pocket limit.
According to MedicareResources.org, your Advantage Plan max out-of-pocket limit has increased from $6,700 in 2020 to $7,550 in 2021. However, Medicare Advantage Plans limits vary from plan-to-plan. For example, your maximum out-of-pocket limit could be as low as $0.
However, Original Medicare has no out-of-pocket limit. Therefore, the amount you pay for Medicare services may be more than $7,550. For example, you could pay $10,000 or more. To reduce your out-of-pocket expenses, we recommend you consider a Medicare Supplement (Medigap) plan.
You can enroll in a Medicare Advantage plan with End-Stage Renal Disease (ESRD). The new ESRD coverage is available on or after January 1, 2021. Original Medicare also accepts all health conditions.
Medicare Advantage (MA) plans may offer you extra benefits, not included in Original Medicare. For example, your MA Plan may include:
In comparison, Original Medicare covers eye exams for diabetes, hearing, and balance exams if your doctor orders them. However, Medicare charges copays for these diagnostic tests. Furthermore, Original Medicare does not cover hearing aids or exams for fitting hearing aids.
Original Medicare does not pay for outpatient dental services. However, Medicare Part A can pay for inpatient emergency or complicated dental procedures.
Discover the differences between Medicare Advantage vs Medigap plans.
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