Medicare Advantage, also known as Medicare Part C, is an alternative to, not a replacement for, original Medicare.
A Medicare Advantage plan is an “all-in-one” plan that bundles Medicare Part A, Part B, and, commonly, 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 Medicare-approved. 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 Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) will come from the Medicare Advantage plan, not original Medicare.
Original Medicare and Medicare Advantage are the two main ways for you to get Medicare.
Original Medicare includes:
- Part A: inpatient hospital stays, some home health care, care in a skilled nursing facility, hospice care
- Part B: outpatient care, ambulance services, medical supplies, certain doctor’s services, preventive services
Medical Advantages plans cover everything included in Medicare Part A and Part B, plus:
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.
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.
With original Medicare, you can buy supplemental coverage, such as a Medigap policy, to get additional coverage for your specific medical concerns.
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.
With original Medicare, you can use any doctor or hospital in the U.S. that takes 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.
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.
Some Medicare Advantage plans offer additional 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, in order to make sure a service or supply is covered by the plan, you may be required to get pre-approval in some cases.
Are you covered when traveling outside of the U.S.?
Original Medicare generally doesn’t cover care outside of the U.S., but you may be able to purchase a Medigap policy for coverage outside the U.S.
Medicare Advantage generally doesn’t cover care outside the U.S. or non-emergency care outside of the plan’s network.
Benefits comparison table
|Benefit||Covered by original Medicare||Covered by Medicare Advantage|
|Medically necessary services and supplies||most are covered||same coverage as original Medicare|
|Drug coverage||available with Part D add on||included with most plans|
|Doctor selection||you can use any doctor who takes Medicare||you can only use in-network doctors|
|Specialist referral||not needed||may need referral|
|Vision, dental, or hearing coverage||available with supplement add on||included with some plans|
|Pre-approval||not typically needed||required in some cases|
|Coverage outside of the U.S.||may be available with purchase of Medigap policy add-on||generally not covered|
With original Medicare, after you’ve met your deductible, you’ll usually pay 20 percent of the Medicare-approved amount for Part B-covered services.
With Medicare Advantage plans you may have lower out-of-pocket costs than original Medicare for certain services.
With original Medicare, there is no yearly limit on out-of-pocket costs.
With Medicare Advantage plans there is a yearly limit on out-of-pocket costs for services covered by Medicare Part A and Part B. 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.
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.
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 more information from:
- 1-800 Medicare (1-800-633-4227)
- Your state’s State Health Insurance Assistance Programs (SHIPS)