Does a Medicare Advantage Plan Replace Original Medicare?

Medicare Advantage, also known as Medicare Part C, is an alternative to original Medicare.

Medicare Advantage is an “all-in-one” plan that bundles Medicare Part A, Part B, and usually Part D. Many Medicare Advantage plans also offer benefits like dental, hearing, and vision that are not covered by original Medicare.

Medicare Advantage plans are offered by private companies that have been approved by Medicare. They are required to follow rules set by Medicare.

If you decide to join a Medicare Advantage plan, you’ll still have Medicare, but most of your Part A (hospital insurance) and Part B (medical insurance) coverage will come from the Medicare Advantage plan, not original Medicare.

Original Medicare and Medicare Advantage

Original Medicare and Medicare Advantage are the two main ways for you to get Medicare.

Original Medicare

Original Medicare includes:

  • Part A covers inpatient hospital stays, some home healthcare and care in a skilled nursing facility, as well as hospice care.
  • Part B covers outpatient care, ambulance services, certain medical supplies, doctor’s services, and preventive services.
Medicare Advantage

Medical Advantages plans cover everything included in Medicare Part A and Part B, plus:

  • Part D prescription drug coverage (most plans)
  • additional coverage (some plans) for eyewear, dental care, and hearing aids and exams

Other differences between original Medicare and Medicare Advantage

With original Medicare, most medically necessary services and supplies in doctors’ offices, hospitals, and other healthcare settings are covered.

With Medicare Advantage, all of the medically necessary services that are covered through original Medicare must be covered.

Drug coverage

With original Medicare, you can join a separate Part D plan, which includes coverage for medications.

With Medicare Advantage, many plans come with Part D already included.

Additional coverage

With original Medicare, you can buy supplemental coverage, such as a Medigap policy, or an add-on Part D plan to get additional coverage.

With Medicare Advantage plans, you cannot buy or use separate supplemental coverage. That means you’ll want to confirm that the plan you choose will cover your needs since you won’t have the option to add supplements to expand your coverage.

Doctor selection

With original Medicare, you can use any doctor or hospital in the United States who accepts Medicare. In most cases, you don’t need a referral to see a specialist.

With Medicare Advantage, you will typically be required to use doctors in the plan’s network and you may need a referral to see a specialist, depending on your plan.

Extra benefits

Original Medicare doesn’t offer extra benefits, such as vision, dental, and hearing. Instead, you’ll need to add on a supplement to receive these benefits.

Many Medicare Advantage plans offer additional coverage benefits.

Pre-approval for services or supplies

With original Medicare, you typically don’t have to get approval ahead of time for coverage of a service or supply.

With Medicare Advantage, you may be required to get pre-approval in some cases to make sure a service or supply is covered by the plan.

Are you covered when traveling outside of the United States?

Original Medicare generally doesn’t cover care outside of the country, but you may be able to purchase a Medigap policy for coverage while traveling abroad.

Medicare Advantage generally doesn’t cover care outside the United States or nonemergency care outside of the plan’s network.

Cost differences between original Medicare and Medicare Advantage

Out-of-pocket costs

With original Medicare, after you’ve met your deductible, you’ll usually pay 20 percent of the Medicare-approved amount for services covered by Part B

With Medicare Advantage plans, you may have lower out-of-pocket costs than original Medicare for certain services.

Yearly limit

With original Medicare, there is no yearly limit on out-of-pocket costs.

With Medicare Advantage plans, there is a yearly limit or “out-of-pocket max.” Once you reach your plan’s limit, you will have no out-of-pocket costs for services covered by Part A and Part B for the rest of the year.

Premiums

With original Medicare, you pay a monthly premium for Part B. If you buy Part D, that premium will be paid separately.

With Medicare Advantage, you may pay a premium for Part B in addition to a premium for the plan itself.

Most Medicare Advantage plans include prescription drug coverage, some offer a $0 premium, and some may help pay all or a portion of your Part B premiums.

The takeaway

Medicare Advantage does not replace original Medicare. Instead, Medicare Advantage is an alternative to original Medicare. These two choices have differences which may make one a better choice for you.

To help with your decision, you can get moreinformation from:

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