Does Medicare Advantage Pay Instead of Medicare?

February 14, 2025•3 min read

Understanding Original Medicare

Original Medicare, also known as traditional Medicare, is a federal health insurance program primarily for individuals aged 65 and older. It consists of two parts: Medicare Part A, which covers hospital stays, and Medicare Part B, which covers medical services like doctor visits and outpatient care. Here are some key points about Original Medicare:

Part A: Hospital insurance that usually doesn't require a premium if you or your spouse paid Medicare taxes while working.
Part B: Medical insurance that requires a monthly premium.
Original Medicare does not include prescription drug coverage (Part D), dental, vision, or hearing care.
You can visit any doctor or hospital in the U.S. that accepts Medicare.

Original Medicare and Medicare Advantage

Medicare Advantage Plans, sometimes called Part C, are an alternative to Original Medicare. These plans are offered by private insurance companies approved by Medicare. They provide all Part A and Part B benefits and often include additional benefits not covered by Original Medicare. Here’s how they compare:

Medicare Advantage Plans cover all services Original Medicare covers, but they may also include dental, vision, and hearing care.
Many Medicare Advantage Plans offer prescription drug coverage (Part D).
These plans often have lower out-of-pocket costs than Original Medicare and may have different rules for how you access care.

Difference Between Original Medicare and Medicare Advantage Plan

One key difference between Original Medicare and Medicare Advantage is how you pay for services and access care. Here are some points to consider:

Original Medicare: You generally pay a deductible and coinsurance for services. You can see any doctor that accepts Medicare.
Medicare Advantage: You might pay copays and coinsurance, but costs are often lower. You may need to use a network of doctors and hospitals.

Compare Original Medicare and Medicare Advantage

When deciding between Original Medicare and a Medicare Advantage Plan, consider the following:

Costs: Compare monthly premiums, deductibles, and out-of-pocket costs.
Coverage: Look at the additional benefits offered by Medicare Advantage Plans, such as dental and vision care.
Provider Access: Original Medicare allows you to visit any provider that accepts Medicare, while Medicare Advantage Plans may require you to use a network.

Medicare Advantage Plan

Medicare Advantage Plans are popular because they often include extra benefits not available with Original Medicare, such as:

Prescription drug coverage (Part D)
Dental, vision, and hearing care
Wellness programs and gym memberships

These plans may have a monthly premium in addition to the Part B premium, but they can offer more comprehensive coverage for Medicare beneficiaries.

What to Consider When Choosing Between Original Medicare and a Medicare Advantage Plan

When choosing between Original Medicare and a Medicare Advantage Plan, think about:

Your Health Needs: Do you need additional benefits like dental or vision care?
Your Budget: Compare the costs of premiums, deductibles, and out-of-pocket expenses.
Your Preferred Providers: Do you want the flexibility to see any doctor, or are you okay with using a network?