Medicare Advantage (Part C)

• You join a Medicare-approved plan from a private company that offers an alternative to Original Medicare for your health and drug coverage.

• In many cases, you can only use doctors who are in the plan’s network.

Includes:

Part A (Hospital Insurance)

Part B (Medical Insurance)

Most plans include:

Part D (Medicare Drug Coverage)

Some extra benefits (that Original Medicare doesn’t cover – like certain vision, hearing, and dental services)

You must have both Part A and Part B to join a Medicare Advantage Plan.

Compare Original Medicare & Medicare Advantage

Things to Consider when choosing between Original Medicare and Medicare Advantage

Doctor & hospital choice

Original Medicare

You can go to any doctor or hospital that takes Medicare, anywhere in the U.S.

In most cases you don’t need a referral to see a specialist.

Medicare Advantage

In many cases, you can only use doctors and other providers who are in the plan’s network and service area (for non-emergency care).

You may need to get a referral to see a specialist.

Original Medicare

For Part B-covered services, you usually pay 20% of the Medicare-approved amount after you meet you deductible. This amount is called your coinsurance

You pay the monthly premium for Part B. If you choose to join a Medicare drug plan, you’ll pay a separate premium for your Medicare drug coverage (Part D).

There’s no yearly limit on what you pay out-of-pocket, unless you have supplemental coverage – like Medicare Supplement Insurance (Medigap),Medicaid, employer, retiree, or union coverage.

You can choose to buy Medigap to help pay your out-of-pocket costs that Medicare doesn't cover (like your 20% coinsurance). Or, you can use coverage from a current or former employer or union, or Medicaid.

Medicare Advantage

Out-of-pocket costs vary. Plans may have different out-of-pocket costs for certain services.

You pay the monthly Part B premium and may also have to pay the plan’s premium. Some plans may have a $0 premium and may help pay all or part of your Part B premium. Most plans include Medicare drug coverage (Part D).

Plans have a yearly limit on what you pay for covered Part A and Part B services (with different limits for in-network and out-of-network services). Once you reach your plan’s limit, you’ll pay nothing for covered services for the rest of the year.

You can’t buy Medigap to cover your out-of-pocket costs.

Cost

Coverage

Original Medicare

Original Medicare covers most medically necessary services and supplies in hospitals, doctors’ offices, and other health care facilities. Original Medicare doesn’t cover some services, like routine physical exams, eye exams, and most dental care.

In most cases, you don’t need approval (prior authorization) for Original Medicare to cover your services or supplies

You can join a separate Medicare drug plan to get Medicare drug coverage (Part D).

Medicare Advantage

Plans must cover all medically necessary services that Original Medicare covers. For some services, plans may use their own coverage criteria to determine medical necessity. Plans may also offer some extra benefits that Original Medicare doesn't cover.

In many cases, you may need to get approval (prior authorization) from your plan before it covers certain services or supplies.

Medicare drug coverage (Part D) is included in most plans. In most types of Medicare Advantage Plans, you can't join a separate Medicare drug plan.

Foreign Travel

Original Medicare

Original Medicare generally doesn’t cover medical care outside the U.S. You may be able to buy a Medicare Supplement Insurance (Medigap) policy that covers emergency care outside the U.S.

Medicare Advantage

Plans generally don’t cover medical care outside the U.S. Some plans may offer an extra benefit that covers emergency and urgently needed services when traveling outside the U.S.