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Original Medicare vs. Medicare Advantage: Understanding the Differences

4 in 10 Medicare beneficiaries are enrolled in Medicare Advantage Plans. This number is expected to increase.

If you or a loved one is becoming eligible for Medicare, it’s critical to understand your options to make sure you get the care you need.

Many people have questions about original Medicare vs Medicare Advantage. Keep reading for a breakdown of each and how to choose the right plan for your needs. 

What is Original Medicare?

When you turn 65, you’re eligible to enroll in Medicare. Original Medicare is the standard policy that gives you healthcare benefits from the federal government.

Original Medicare can be used to pay for medical and hospital costs. It is not customizable.

Some people that have not yet turned 65 may be eligible to enroll in a Medicare plan including people with certain disabilities or medical conditions.

Medicare was created in 1965 by the Social Security Administration (SSA). It is now administered by the Centers for Medicare and Medicaid Services (CNS).

Medicare Advantage Plans

Medicare Advantage plans have some similarities to original Medicare. For example, they have to offer the same benefits as Medicare when it comes to Parts A and B. However, they also offer additional benefits and more coverage.

Medicare Advantage was first introduced in 1995 by the federal government. The idea was to give older Americans more options when it comes to their healthcare.

Medicare Advantage Plans are sold by private health insurance companies. An example is Cigna Medicare plans. They are regulated by the federal government. 

Original Medicare vs Medicare Advantage

Original Medicare only covers certain medical and hospital costs. Medicare Advantage plans often cover additional expenses including prescription drugs, hearing, vision, and dental.

With original Medicare, there is no cap on what you could end up paying out of pocket. There is also a limit to how long you can stay in a hospital or nursing facility. On the other hand, Medicare Advantage plans have an annual out-of-pocket maximum.

Original Medicare also doesn’t provide coverage when you’re outside of the country. Medicare Advantage plans often offer emergency coverage up to a certain amount outside of the country.

Original Medicare uses a coinsurance system where you pay a portion of the costs out of pocket. Medicare Advantage plans use copays, where you pay a fixed amount.

Finally, original Medicare recipients can seek care at any facility that accepts Medicare. If you have a Medicare Advantage plan, you will have a network of preferred providers.

 The best plan for you depends on what care you expect to need and what you can afford to pay out of pocket.

Are You Looking for More Health Content?

As we age, it’s important to be as educated as possible about our healthcare options. When it comes to the question of original Medicare vs Medicare Advantage, the right choice for you depends on your needs.

Check out the rest of our blog for more health and lifestyle content. 

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