What's the Difference Between Original Medicare and Medicare Advantage?

All Medicare Advantage plans have to offer at least the same benefits as Original Medicare. 

Beyond that, there are several ways these programs differ.


Original Medicare only covers certain medical and hospital costs. It doesn't cover long-term care. Original Medicare provides limited coverage for dental, vision and hearing care. You can learn more about what Original Medicare does and doesn't cover at Medicare.gov.

The benefit of Medicare Advantage plans is that they offer more coverage than Original Medicare. Most plans include some level of dental, vision, hearing and prescription drug coverage.

Blue Cross Blue Shield of Michigan Medicare Advantage plans offer comprehensive dental and vision coverage and most include a hearing aid allowance. Most of our plans include prescription drug coverage, too.


Original Medicare doesn't put a limit on your costs. It only pays for a certain number of days when you're in the hospital or a skilled nursing facility.

Medicare Advantage plans limit your costs with what's called an out-of-pocket maximum. Once you hit a certain dollar amount, your plan pays 100% of your costs for covered services.

Coinsurance vs. copay

With Original Medicare, you pay 20% of the cost, or 20% coinsurance, for services like office visits.

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. If you have Original Medicare, you’ll pay 20% of the total cost of the visit. If the visit costs $200, you pay $40.

It can be tricky to estimate your costs with coinsurance, whereas copays are always a fixed amount as listed in your plan benefits.

Who you can see

With Original Medicare, you can see any doctor who accepts Medicare.

Medicare Advantage plans have fixed networks of doctors and hospitals. Your plan will have rules about whether you can get care outside your network. If you can see someone outside the network, you'll pay more.

Though Medicare Advantage plans have rules about who you can see, BCBSM's network includes more than 80,000 doctors in Michigan and more than 1.7 million doctors nationwide. So you can rest assured that you're covered with one of our plans. 


Original Medicare typically doesn't cover you when you travel outside of the U.S., except in very limited emergency circumstances. 

Medicare Advantage plans cover emergency care, depending on what plan you have.

Blue Cross Medicare Advantage plans cover emergency care outside of the U.S. with a $50,000 lifetime maximum.

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