Original Medicare and Medicare Advantage are two different ways to receive your Medicare benefits.
Original Medicare is administered by the federal government and generally allows you to use any provider nationwide who accepts Medicare.
Medicare Advantage benefits are administered through private Medicare-approved plans that may use provider networks, prior authorization and plan-specific cost sharing.
Neither option is best for everyone.
With Original Medicare, you can generally use doctors and hospitals nationwide that accept Medicare.
With Medicare Advantage, your provider access can depend on the plan’s network and rules.
Original Medicare generally doesn’t require prior authorization for most services.
Medicare Advantage plans may require authorization before certain services are covered.
Original Medicare by itself has no annual maximum out-of-pocket limit for Part A and Part B expenses.
A Medigap policy can reduce much of that exposure.
Medicare Advantage plans have an annual maximum out-of-pocket limit for covered Part A and Part B services.
With Original Medicare, you generally purchase a separate Part D plan.
Most Medicare Advantage plans include prescription drug coverage.
Medicare Advantage plans may offer services that Original Medicare doesn’t ordinarily cover, such as certain dental, vision, hearing or fitness benefits.
Compare the medical coverage first—not just the extras.
Original Medicare or Medicare Advantage?
I don’t think this decision should be made based on a television commercial.
The most important differences aren’t the free gym membership or dental allowance.
I focus on:
Provider access
Prior authorization
Potential annual healthcare costs
Ability to travel
Ability to obtain a Medigap policy later
Those issues can become much more important when your health changes.
Medicare Advantage plans cover Medicare-covered cancer treatment, including qualifying chemotherapy, but plan networks, prior authorization rules and out-of-pocket costs can become especially important when someone has cancer.
Medicare’s Annual Enrollment Period, also commonly called Medicare Open Enrollment, runs, October 15 through December 7 each year.
