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 2024
The 2024 chart below compares the differences between Original Medicare vs. Medicare Advantage. Original Medicare provides nationwide coverage and access to more doctors and hospitals without referrals. In comparison, Medicare Advantage provides local or regional coverage for doctors and hospitals in-network. Use the following chart to compare Original Medicare and Medicare Advantage.
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 NCOA.org , the max out-of-pocket limit for Medicare Advantage plans has increased to $8,850 for 2024. However, Medicare Advantage plan limits vary from plan to plan.
Original Medicare has no out-of-pocket limit. Therefore, you may pay more than $8,850 for Medicare services. 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. Discover the following extra benefits that may be available on Advantage plans.
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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