There are several major differences in coverage when comparing Medicare Advantage with Original Medicare. For example, Medicare Advantage charges copays for each doctor visit or medical service, while 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 2022 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. Use this chart to compare Original Medicare and Medicare Advantage carefully.
To enroll in Medicare Advantage (MA) plan, you must have Medicare Part B and pay the monthly premium. In 2022, the standard Medicare Part B premium is $170.10. However, beneficiaries who earned more in 2020 than $91,000 individually or $182,000 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 $21 per month.
A significant difference between Medicare Advantage vs. Original Medicare is prescription drugs. Many Medicare Advantage plans include prescription drug coverage.
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.
According to MedicareResources.org, the Advantage Plan max out-of-pocket limit has remained the same at $7,550 for 2022. However, Medicare Advantage Plans limits vary from plan-to-plan.
Original Medicare has no out-of-pocket limit. Therefore, the amount you pay for Medicare services may be more than $7,550. A Medicare Supplement (Medigap) plan can help reduce your out-of-pocket expenses.
What is the difference between Original Medicare and Advantage plans. then? There are quite a few, and it can still be confusing to know which type is best for your needs.
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.
It’s not easy to know whether Original Medicare or a Medicare Advantage plan is the best choice for you. Our licensed agents can help you determine which option would be the best fit for your needs right now. We’ll guide you in making decisions that fit your needs while explaining every detail clearly for you. Let us help you decide what type of coverage you need.