What’s the Difference Between Original Medicare & Advantage?

Original Medicare is provided by the government, while an Advantage plan is offered by private insurance companies that have a contract with Medicare.  Both are insurance, but they can look very different – like comparing apples to oranges. Here are some comparisons to consider –

COSTS: 
Original Medicare – Parts A & B premiums, deductibles, and coinsurance (usually 20%).
Advantage – Parts A & B premiums, plan premiums (if the plan has one) copays & coinsurance up to the plans Annual Out-of-Pocket Maximum cost share.

SUPPLEMENT INSURANCE:
Original Medicare – you can purchase a supplemental policy to pay for some or all of the costs Medicare does not cover.
Advantage – you cannot have a supplemental policy AND Advantage at the same time.

EXTRA SERVICES:
Original Medicare – covers only medically necessary services, does not cover routine services.
Advantage – many plans cover routine services (such as dental, eyecare & hearing) as well as gym memberships, over-the-counter items, etc.

NATIONWIDE PROVIDERS:
Original Medicare – ability to see any provider nationwide that accepts Medicare.
Advantage – usually restricted to network providers the plan has set up (PPO does allow more provider choices at higher costs).

DRUG COVERAGE:
Original Medicare – does not cover prescription drugs.  You must purchase a separate stand-alone drug plan.
Advantage – many plans include prescription drug coverage – saving you money.

OUT-OF-POCKET LIMITS:
Original Medicare – there is no limit on what the beneficiary can spend on healthcare.
Advantage – all plans must have an annual cost-share limit.  Once you reach this, you don’t owe any more for services.  The maximum is $6,700, but many plans are lower than that.

Still confused?  Why not visit with a professional Medicare insurance agent and let them help you compare coverage to see what fits your needs?  Call, click or come in today!  You’ll be glad you did.  Never a fee for appointments!