Original Medicare Vs. Medicare Advantage

Original Medicare

Original Medicare by itself is just a starting point; it covers doctor visits and hospital stays.  You usually pay a monthly Part B premium and must meet yearly deductibles.  Original Medicare will then cover 80% of the approved amount and you’re responsible for the remaining 20% of the costs.  Part D (prescription drug coverage) is not included and you would have to purchase a stand-alone prescription drug plan to have coverage and avoid a Late Enrollment Penalty (LEP). 

There is no limit to your out-of-pocket costs each year.

Medicare Advantage

Medicare Advantage plans include Part A and Part B benefits and most include coverage for prescription drugs (Part D).  Most plans include coverage for dental, vision and hearing-benefits not offered by Original Medicare Parts A and B.  Most Medicare Advantage plans have no additional premium and a cap to your yearly out-of-pocket expenses. 

If you reach the maximum out-of-pocket amount, you pay nothing for your covered in-network services for the rest of the calendar year.