Original Medicare vs. Medicare Advantage Plans

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Millions of Americans 65 years of age or older are eligible to receive Medicare health insurance benefits. These benefits packages come in several parts and include "Original Medicare," which contains Medicare Parts A and B, and "Medicare Advantage" plans, also known as "Medicare Part C." Original Medicare and Medicare Advantage plans have different cost schedules and offer different benefits. Participants must be aware of these differences to receive their full benefits.

Plan Availabilty

Original Medicare is operated by the federal government. Original Medicare benefits are available to all American citizens who have reached 65 years of age, as well as legal permanent residents who have lived in the U.S. for at least five years. Medicare Part A covers hospital stays, while Part B covers physician visits, nursing costs and equipment expenses. Medicare Advantage plans are purchased through private insurers, so the availability, benefits and costs of each plan vary by location.

Provider Choice

Original Medicare allows participants the ability to choose physicians, hospitals and specialists. The Original Medicare program does not limit the patient's choices to doctors and hospitals in a specific network. Since Medicare Advantage resembles a Preferred Provider Organization (PPO) in its structure, Medicare Advantage patients who visit health care providers who are not part of that insurer's network will pay higher rates. Patients with Medicare Advantage plans must also typically get a referral to visit a specialist.

Benefits Coverage

A major difference between the Original Medicare and Medicare Advantage plans lies in its prescription drug coverage. Since Medicare Parts A and B do not provide for prescription drug benefits, patients need a separate plan to cover their prescription drug costs. Medicare Advantage plans commonly include prescription drug coverage, either as "Medicare Part D" or as a separate plan. Some Medicare Advantage plans also include benefits such as dental care, vision tests and hearing aids that are not available under Original Medicare.

Out-of-Pocket Costs

Medicare plans often do not cover the full costs of care. Monthly premium payments are not required for Original Medicare Part A participants who have paid into the plan for at least ten years. However, participants are required to pay monthly premiums for their Part B coverage. Medicare Advantage plans require a monthly premium payment, as well as deductibles and co-payments; these payment schedules vary among insurance providers.


About the Author

Living in Houston, Gerald Hanks has been a writer since 2008. He has contributed to several special-interest national publications. Before starting his writing career, Gerald was a web programmer and database developer for 12 years.

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