Original Medicare vs. Medicare Advantage: We Explain the Key Differences
When you become eligible for Medicare, one of the first and most important decisions you'll make is how you want to receive your benefits. There are two main ways to get your Medicare coverage, and understanding the difference between them is the foundation for making a choice you feel good and certain about.
At Health Benefits Enrollment Center, we want to provide a straightforward look at these two options: Original Medicare and Medicare Advantage.
What is Original Medicare?
Original Medicare is the traditional health insurance program run by the federal government. It is made up of two parts:
Part A (Hospital Insurance): This helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care. For most people who have worked and paid Medicare taxes, Part A is premium-free.
Part B (Medical Insurance): This helps cover services from doctors and other healthcare providers, outpatient care, medical supplies, and preventive services. You will typically pay a monthly premium for Part B.
Key Features of Original Medicare:
Freedom of Choice: With Original Medicare, you have the freedom to go to any doctor, hospital, or other facility in the U.S. that accepts Medicare. You generally do not need a referral to see a specialist.
Coverage Gaps: Original Medicare does not cover everything. It does not include coverage for most prescription drugs, routine dental care, vision exams, or hearing aids. To cover these, you often need to purchase separate, additional plans.
Part D: A standalone plan from a private insurer that helps cover prescription drug costs.
Medigap (Medicare Supplement Insurance): A plan from a private insurer that helps pay for your out-of-pocket costs in Original Medicare, like your deductibles and coinsurance.
Original Medicare is often a good choice for those who value maximum flexibility in choosing their doctors and hospitals nationwide.
What is Medicare Advantage (Part C)?
Medicare Advantage, also known as Part C, is an "all-in-one" alternative to Original Medicare. These plans are offered by private insurance companies that are approved by Medicare.
Key Features of Medicare Advantage:
Bundled Coverage: By law, Medicare Advantage plans must provide all the same benefits as Original Medicare (Part A and Part B). However, they often bundle these benefits together with others.
Extra Benefits: Most Medicare Advantage plans include additional benefits that Original Medicare doesn't cover. This frequently includes:
Prescription drug coverage (Part D).
Routine dental, vision, and hearing services.
Wellness programs and gym memberships.
Network Structure: Most Medicare Advantage plans operate with a provider network, such as an HMO or a PPO. You will typically need to use doctors, hospitals, and specialists within that network to get the lowest costs.
Cost Structure: These plans often have low, and sometimes even $0, monthly premiums (beyond what you already pay for Part B). Your out-of-pocket costs are structured with copays and coinsurance, and all plans have an annual out-of-pocket maximum, which limits how much you'll spend on covered services in a year.
Medicare Advantage can be a good choice for those who prefer the convenience of having all their benefits in a single plan and are comfortable using a network of providers.
Your Next Step: Understanding the Enrollment Process
Neither option is automatically better than the other; the right choice depends on your healthcare needs, budget, and personal preferences. Understanding this fundamental difference is the most important first step.
When you're ready to explore the enrollment process, our self-help enrollment center at https://easybenefits.hbecenter.com/ provides clear, step-by-step video guidance from our founder, Robert Lewis. We're here to help you understand the process so you can move forward with certainty.
