Traditional Medicare and Medicare Advantage are two insurance options for people ages 65 and older living in the United States.
Traditional Medicare and Medicare Advantage are not the same, and depending on your situation, there are advantages and disadvantages for each.
Your medical needs, budget, and other personal lifestyle factors can all play a role in which type of Medicare coverage is better for you.
In this article, we’ll explore the differences between Traditional Medicare and Medicare Advantage, and how to decide which one is better for your medical needs.
Traditional Medicare, also known as Original Medicare, is a government-funded medical insurance option for people ages 65 and older. Many older Americans use Medicare as their primary insurance option, since it covers:
- Hospital-related services (Part A). These benefits include coverage for hospital visits, nursing facility care, at-home health care, and hospice care.
- Medical services (Part B). These benefits include coverage for preventive, diagnostic, and treatment services for health conditions.
Medicare generally doesn’t cover prescription drugs, dental, vision or hearing services, or additional healthcare needs.
However, for people who have enrolled in Original Medicare, there are add-ons such as Medicare Part D and Medigap that can offer additional coverage.
Medicare Advantage, also called Medicare Part C, is an insurance option for people who are already enrolled in Medicare Part A and Part B.
Advantage plans are offered through private insurance companies, and many plans cover hospital, medical insurance, and additional services such as:
- prescription drugs
- dental services
- vision services
- hearing services
- fitness services, plus other health perks
Medicare Advantage takes the place of traditional Medicare add-ons, such as Part D and Medigap.
Instead of having multiple insurance plans to cover medical costs, a Medicare Advantage plan offers all your coverage in one place.
Original Medicare and Medicare Advantage differ in their coverage, costs, and benefits. When comparing your options, there’s no “one plan fits all.”
If you’re someone who rarely visits the doctor, Medicare and Medicare add-ons may cover most of your needs.
However, if you’re someone who wants coverage for yearly dental, vision, or hearing exams, many Medicare Advantage plans offer this type of coverage.
If you have a chronic health condition, such as cancer, chronic heart failure, stroke, dementia, or other condition, it’ll affect your medical coverage.
For example, Medicare may not cover all your needs, but a Medicare Advantage Special Needs Plan (SNP) could help with long-term costs.
These plans are designed for people with one of several chronic health conditions. They offer:
- coverage for specialists and case managers
- access to medications specifically for your condition
- access to other benefits
Research has shown that Medicare Advantage plans can help consumers save more money on certain medical necessities, such as laboratory tests and medical equipment.
Original Medicare generally doesn’t cover prescription drug costs. In order to receive coverage for prescription drugs, you need a Medicare Part D plan or Medicare Advantage plan with prescription drug coverage.
No matter what option you choose, you’re required to have some form of prescription drug coverage within 63 days of enrolling in Medicare, or you’ll be required to pay a permanent penalty.
If you have Medicare, you’ll pay a monthly premium for Part A (if you don’t qualify for premium-free Part A) and Part B, a yearly deductible for Part B, and other costs if you have add-ons.
If you have Medicare Advantage, you may need to pay additional costs depending on the plan. Before choosing the type of plan you want, consider what out-of-pocket costs you can afford each year.
While Medicare offers the freedom to choose any provider within the Medicare network, most Medicare Advantage plans don’t provide as much freedom.
Depending on the type of Advantage plan you have, you may face additional costs for out-of-network services, as well as specialist referrals and visits.
For some people, travel is a way of life. This is especially true for people who retire and choose to travel or who live some place warmer during the colder months.
If you travel frequently, consider what out-of-state medical needs you may have. In most cases, Medicare coverage is nationwide, while Medicare Advantage plans require you to stay in your local area for medical services.
To decide whether Original Medicare or Medicare Advantage is better for you, it’s important to know what each plan covers.
Below you’ll find a comparison of the benefits Medicare vs. Medicare Advantage offer:
|Service||Original Medicare||Medicare Advantage|
|Prescription drugs||No |
(Optional: Part D)
|Dental||No||Yes (most plans)|
|Vision||No||Yes (most plans)|
|Hearing||No||Yes (most plans)|
|Yes (some plans)||Yes|
|Yearly out-of-pocket |
|Health perks||No||Yes (some plans)|
For some people, Medicare Advantage plans can help save money on long-term medical costs, while others prefer to pay for only what they need with Medicare add-ons.
Below you’ll find an estimated cost comparison for some of the fees associated with Medicare vs. Medicare Advantage:
|Original Medicare||Costs||Medicare |
|Part A monthly premium||$240-$437 |
|Part B monthly premium||$135.50+ (or free)|
|Part A deductible||$1,364 each benefit period||Advantage plan monthly premium||varies (can start at $0+)|
|Part A coinsurance||$341-$682+||Advantage plan deductible||varies (can start at $0+)|
|Part B monthly premium||$135.50+||Advantage plan drug deductible||varies (can start at $0+)|
|Part B deductible||$185 each year||Advantage plan coinsurance|
|varies (generally $25-95 per visit)|
|Part B coinsurance||20% of all medical services |
after deductible is met
|maximum out-of-pocket yearly cost||$1,000-|
Enrolling in Medicare is a time sensitive process that you should begin roughly 3 months before your 65th birthday to ensure that you don’t have a gap in your coverage.
If you receive social security benefits, you’re automatically enrolled in Medicare Part A and B.
You can also apply for Medicare 3 months before your 65th birthday and up to 3 months after you turn 65. If you decide to wait to enroll until after that period, you may face late enrollment penalties.
When you apply for Medicare, you’ll need to have some important personal information handy.
This includes your place and date of birth, Medicaid number, and any current health insurance information. Once you have this information, you can apply on the Social Security Administration website.
You won’t be able to enroll in a Medicare Advantage plan until you have been enrolled in Medicare Part A and B.
To find a list of Medicare Advantage plans or Part D plans near you, use the Find a 2020 Medicare plan tool on the Medicare.gov website.
Finding a health insurance plan that covers all your medical needs is based entirely on your personal situation.
Both Original Medicare with add-ons and Medicare Advantage offer coverage, costs, and benefits to fit your needs.
When comparing which option is better for you, be sure to consider:
- your medical situation
- monthly and yearly budget
- preference for providers
- other lifestyle factors that can impact your care and costs
You don’t have to wait until you apply for Medicare to begin shopping around for plans in your area. Get a head start on choosing the best health insurance plan for 2020 right now.
The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.