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What Are Differences Between Medicare Advantage And Original Medicare?

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.

Original Medicare Vs Medicare Advantage

Understanding the difference between traditional Medicare and Medicare Advantage is critical when trying to decide what type of coverage is best for you. Under Original Medicare, the government directly pays for your Medicare benefits and includes Part A and Part B coverage, with optional Part D plans paid for separately. With Medicare Advantage plans, you receive your benefits from private medical insurance companies that Medicare has approved.

Original Medicare & Medicare Advantage In 2023

The 2023 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.

Advantage vs Original Medicare 2023.png

Premium Costs: Original Medicare Vs. Advantage Plans

To enroll in Medicare Advantage (MA) plan, you must have Medicare Part B and pay the monthly premium. In 2023, the standard Medicare Part B premium is $164.90. However, beneficiaries who earned more in 2021 than $97,000 individually or $194,000 jointly may pay higher Part B premiums.

Furthermore, you may have to pay additional Advantage Plans premiums. According to KFF.org , the average 2023 premium is expected to be $18 per month.

Prescription Drugs Costs: Medicare Advantage Vs. Original Medicare

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.


Max Out-Of-Pocket Limit: Medicare Advantage Vs. Original Medicare

According to MedicareResources.org , the Advantage Plan max out-of-pocket limit has increased to $8,300 for 2023. 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 $8,300. 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.

Extra Benefits For Medicare Advantage

Medicare Advantage (MA) plans may offer you extra benefits, not included in Original Medicare. For example, your MA Plan may include:

  • Dental

  • Vision

  • Hearing

  • Fitness Program

  • Transportation

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.

What Can Senior Healthcare Direct Do For You?

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.

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