Check out this helpful side-by-side comparison of Original Medicare and Medicare Advantage
You have choices—and that’s a good thing! Knowing which features are most important to you makes it easier to choose the plan type that best meets your needs. Let’s compare Medicare and Medicare Advantage side-by-side to help you better understand each plan’s advantages.
What it is
Offered by the federal government, it includes Part A (hospital insurance) and Part B (medical insurance) benefits.
Called Medicare Part C and administered by private insurance companies, MA plans provide all the benefits of Original Medicare, but most MA plans offer much more.
What it covers
Original Medicare helps cover hospital and doctor visits.
MA plans include Part A and Part B benefits, and most plans also include coverage for prescription drugs. Many MA plans also include coverage for routine dental, vision and hearing care—benefits not offered by Original Medicare Parts A and B.
Maximum out-of-pocket cost guarantee
There is no maximum out-of-pocket cost guarantee with Original Medicare.
MA plans have a yearly limit on out-of-pocket costs for medical services, after which members pay nothing for covered services for the rest of the plan year. For 2022, in most cases the out-of-pocket maximum can be no more than $7,050.
Doctors and hospitals
If you are enrolled in Original Medicare, you can go to any doctor or hospital in the U.S. that accepts Medicare.
MA plans generally require you to use doctors and facilities in the plan's network. If you see an out-of-network provider, your costs may be higher.
Premiums
You usually don't pay a monthly premium for Medicare Part A (hospital) coverage if you or your spouse paid Medicare taxes for a certain amount of time while working.
You do need to pay a premium for Part B coverage. In 2022, the Medicare Part B premium is $170.10 or higher, depending on your income.
Many Medicare Advantage plans offer an affordable or $0 monthly plan premium.
As with Original Medicare, Medicare Advantage members must continue to pay a monthly Part B premium ($170.10 in 2022), along with any MA plan premium.
Deductibles and coinsurance
The 2022 Part A deductible for inpatient hospital coverage is $1,556.00.
The 2022 annual deductible for Part B medical coverage is $233.00.
Deductibles and copays vary depending on the Medicare Advantage plan.
Prescription drug coverage
Original Medicare does not include prescription drug coverage. You may choose to purchase a stand-alone prescription drug plan from a private company.
Most Medicare Advantage plans include coverage for prescription drugs although there are also MA plans that cover medical services only.
Can I change my plan if I don’t like it?
Yes.
You can switch from Original Medicare to Medicare Advantage, or vice versa, each year during the Annual Election Period (AEP), which runs Oct. 15–Dec. 7.
Yes.
You can switch to another Medicare Advantage plan or switch to Original Medicare each year during the Annual Election Period (AEP), which runs Oct. 15–Dec. 7.
When reviewing your options and comparing Medicare Advantage plans, here are some important things to remember:
How much will you pay for premiums, deductibles, coinsurance and copayments?
Does the plan have a network? Do the healthcare providers you use accept the plan?
Does the plan include prescription drug coverage or coverage for vision, dental and hearing care? Are these benefits important to you?
How often have you needed care over the past few years? Are you fairly healthy or do you have a chronic condition that requires ongoing care? Do you anticipate that your healthcare needs will increase or stay about the same in the near future?
Medicare costs
Prescription savings options for members of Medicare Part DMedicare costs
How much will Medicare Parts A, B, C and D cost?Medicare explained
Medicare vs. Medicaid: What’s the difference?
