Medicare Advantage plans are bundled alternatives to Original Medicare. These plans come from private insurance companies that contract with the federal government. The goal is to offer various health insurance benefits for people who qualify for Medicare. So, what’s the difference between Medicare Advantage and Original Medicare? We’ll break this down for you below. 

Medicare Advantage Plans – How They Work

Many people refer to Medicare Advantage (MA) plans as Medicare Part C. MA plans have to give you a minimum of the same benefits that you’d get with Original Medicare. Many Medicare Advantage plans also offer coverage for Medicare Part D prescription drug coverage, and it can have additional benefits that you don’t get with Original Medicare. For example, some Medicare Advantage plans have coverage for eye exams, routine dental care, hearing aids, and glasses. 

What’s the difference between Medicare Advantage and Original Medicare?

Some Medicare Advantage plans can come with specific provider networks that you have to use that can limit your choices as to which doctors you visit. If you go to a doctor outside of the network, the plan may not cover your expenses, or you’ll pay more than an in-network visit. Original Medicare allows you to usually use any medical facility or doctor that accepts Medicare assignment, so you may have more freedom. 

In a Medicare Advantage plan, you will likely still have to pay the monthly premium for Part B, but any additional costs for the Medicare Advantage Plan can be less than what you’d spend on a Medigap plan. Sometimes, a Medicare Advantage Plan can have a $0 premium attached to it. 

Medicare Advantage plans might also have a maximum out-of-pocket limit for what services they cover. This cap is what you’ll have to pay in addition to your normal premiums. For 2022, this cap is $7,550. Original Medicare does not have an annual limit to how much you may spend, so depending on your healthcare needs, your costs can add up.

Medicare Advantage Plans and Medigap Plans

It’s easy to confuse Medicare Advantage plans with Medigap, or Medicare Supplement, Insurance. Private insurance companies offer both, but they differ in how they cover your expenses. Medigap plans work to cover any coverage gaps Original Medicare leaves by covering roughly 20% of your covered charges. When you go to the doctor, Medigap will cover all or most of your cost-share. You’ll pay a monthly premium for Medigap. 

By contrast, Medicare Advantage plans are bundled plans that have the same coverage you’d get if you enrolled in Original Medicare with the addition of limited coverage for other things like dental. You might have a premium with this plan, but many don’t have anything beyond Medicare Part B’s premium. Instead, you’ll pay coinsurance or copays for your medical care. 

Each Medicare Advantage plan differs, so comparison shopping for them can be a challenge. You can’t have a Medigap policy and a Medicare Advantage plan at the same time. 

How to Enroll in a Medicare Advantage Plan

If you’ve decided that you want to enroll in a Medicare Advantage plan instead of Original Medicare, you’ll have to enroll. You’ll need the date your Original Medicare started and the Medicare number when you call to enroll. You have to enroll in Medicare Part A and Part B before you can choose and enroll in a Medicare Advantage plan. The price will vary from plan to plan, so you want to make sure you double-check before you settle on one specific plan.

Related articles:

How Do You Pay for a Medicare Supplement (Medigap) Policy?(Opens in a new browser tab)

What are Guaranteed Issue Rights?(Opens in a new browser tab)