Original Medicare vs. Medicare Advantage: What’s the Difference?

Health insurance plans and policies can often be difficult to understand, especially for those of retirement age who are insured by Medicare which can be overwhelming with all of the rules and regulations surrounding this type of coverage.

When a person in the United States reaches the age of 65 they are eligible for Medicare, a national health insurance program.  Federally funded since 1966, Medicare covers the health care costs of the elderly, some young people with disabilities, and those with end-stage renal failure.  You’ll hear terms such as Part A, Part B, Part D and Part C or Medicare Advantage.  Part A refers to the original Medicare plan involving hospital stays, surgery, and is also thought of as “hospital insurance”.  Part B is also part of the original Medicare plan which applies to doctor’s appointments, routine healthcare, and is referred to as “medical insurance”.  You’ll hear about additional plans to help alleviate some of the expense with extra medical costs such as the 20% co-insurance or medications.  Part D is an additional, supplemental plan that a person can purchase that helps alleviate the costs of prescription medications. 

Medicare Advantage is a newer choice, established in 1997.  Sometimes called Part C or a MA Plan, Medicare Advantage provides an all-encompassing plan, similar to a traditional HMO or PPO insurance plan.  If you purchase a Medicare Advantage plan, you will be required to utilize doctor’s that are “in-network” but it will cover hospitalizations, routine doctor care and medications.  It may even provide additional benefits depending who you purchase your plan from such as dental, hearing, vision, and more.

I urge patients to contact us with any questions they have concerning their healthcare benefits, especially prior to scheduling an appointment. It’s much better to know up front what to expect in terms of cost and what the insurance policy covers. Another great resource for cost breakdown and much more detailed information is available online at https://www.medicare.gov.