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What's the difference between Original Medicare and Medicare Advantage?

Who is this for?

Learn more about how Medicare works.

If you're new to Medicare, this page will help you understand what you get from Medicare Advantage that you don't with Original Medicare. 

You’re probably familiar with Original Medicare. You may know that when you turn 65 you'll get certain health care benefits from the government. You might not know as much about Medicare Advantage.

Medicare Advantage got its start in 1995. The federal government created it as a way to give people more options. Private health insurance companies sell Medicare Advantage plans. The federal government regulates them.

Before we get into how Medicare Advantage is different from from Original Medicare, let’s look at how it’s the same. All Medicare Advantage plans have to offer at least the same benefits as Medicare Parts A and B. That means if Original Medicare covers hospital care at a certain level, so will every Medicare Advantage plan on the market.

But the benefit of Medicare Advantage plans is that they offer more coverage than Original Medicare. Here are three key ways in which Medicare Advantage gives you more than Original Medicare:


Original Medicare Medicare Advantage
Coverage Covers medical and hospital costs only. Many plans cover dental, vision, hearing and prescription drugs, in addition to medical and hospital costs.
Cost No cap on what you pay out of pocket. Medicare only pays for a certain number of days in the hospital or in a skilled nursing facility. Has an out-of-pocket maximum each year. Once you hit a certain dollar amount, your plan pays 100% of the cost for most services it covers.
Travel Except in very rare cases, Medicare doesn't cover care you get when you're out of the country, even in an emergency. May cover emergency care when you’re out of the country. Our plans cover emergency care with a $50,000 lifetime maximum.

Many Medicare Advantage plans offer even more benefits than those listed in the table above. Check out our Medicare Advantage plans to get a better idea of what you can get with these plans.

More differences

There are a few other key differences between Medicare Advantage and Original Medicare:

Coinsurance vs. copay

With Original Medicare, you pay 20 percent of the cost, or 20 percent coinsurance, for common health services like office visits or outpatient surgery. Most Medicare Advantage plans use copays instead of coinsurance for these services. That means you pay a fixed cost.

For example, your Medicare Advantage plan might have a $15 copay when you see the doctor. That means you’ll pay $15 every time you see the doctor, no matter how much the visit costs your health insurance company. If you have Original Medicare, you’ll pay 20 percent of the total cost of the visit. If the visit costs $200, you pay $40.

Network

With Original Medicare, you can go to any doctor or facility that accepts Medicare. Medicare Advantage plans have fixed networks of doctors and hospitals. Your plan will have rules about whether or not you can get care outside your network. But with any plan, you’ll pay more for care you get outside your network.

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Page Last Updated Fri Jun 27 16:57:44 EDT 2014