What do Medicare Advantage plans offer that Original Medicare doesn't?

Generally, a Medicare Advantage plan (Medicare Part C) offers more coverage than Original Medicare.

Many people think Original Medicare alone is enough coverage without realizing that it usually pays for only 80% of many costs. In general, you pay a 20% coinsurance and deductibles for services received under Medicare.

A Medicare Advantage plan may:

  • Simplify your coverage, with only one benefit plan and one membership card
  • Offer more benefits than Original Medicare covers
  • Have different cost-sharing (for example, copays and coinsurance) than Original Medicare
  • Offer out-of-pocket cost limits on some services
  • Provide Part D prescription drug coverage
  • Use provider networks, which means that you will generally have lower costs if you use doctors and hospitals within the plan's network.
  • Charge a monthly premium in addition to the Part B premium

Your helpful decision guide

Here's how to make choosing your coverage easier.

6 steps for choosing a plan:

  1. Review your options. You have three basic ways to get Medicare coverage:
  2. List your healthcare needs.
    • What healthcare services do you use regularly?
    • How often do you see your primary care provider (PCP)?
    • How many specialists do you see a year?
    • Are you anticipating any special needs, such as surgery?
    • After you've made your list, check to see if these services are covered in the plans you're considering and compare out-of-pocket costs such as copays, coinsurance, and deductibles.
  3. List your prescription drugs.
    • This list will help you determine which is best for you, a standalone Medicare Prescription Drug plan or a Medicare Advantage plan that includes prescription drug coverage. Check each plan's formulary (a list of drugs that are covered) to make sure your drugs are covered. Also compare out-of-pocket costs
  4. List your doctors and pharmacies.
    • Check to see if they participate in the networks of any plans you're considering.
  5. Decide whether you need out-of-network benefits.
    • If you spend a significant part of the year in a second home, you need Medicare coverage that will travel with you. Check to make sure the plans you're considering allow you to receive coverage outside of their network. If you plan to travel outside the United States, make sure that your plan provides coverage for emergency care outside the country.
  6. Determine your budget.
    • If you don't have many medical expenses, you may benefit from a plan with a low premium or no premium at all. These plans often have higher out-of-pocket expenses than plans with premiums but may be more cost-effective if you don't use many services. Be sure to compare all the costs of the plans you're considering, including premiums and out-of-pocket expenses, before making your decision.

Do you need out-of-network care?

There are a few reasons you might need out-of-network coverage:

  • If you think you might need to see a specialist or use a hospital outside of the network
  • If you spend a significant part of the year away from your primary home

You will want to make sure your services will be covered if you are outside of the plan's network of doctors and hospitals.

If you do not have prescription drug coverage when you are first eligible for Medicare, you may be subject to a penalty.

You can get coverage for your prescription drugs costs either with the Medicare Part D prescription drug plan or through a Medicare Advantage plan that includes drug coverage. You cannot be enrolled in both types of plans at the same time. There are some cases where people get drug coverage through a retiree benefit plan.

If you don't have dental coverage, you should consider it. Dental work can be expensive. More importantly, regular checkups can help reveal early warning signs for other diseases. Original Medicare does not cover dental expenses. Check to see whether the plans you are considering offer additional dental coverage.

Original Medicare generally does not cover eye exams or help pay for eyeglasses. Medicare Advantage plans usually do offer some type of vision benefit.

Generally, you will not have to pay a premium for Medicare Part A, which covers expenses like hospital stays. You will have to pay a premium for Medicare Part B, whether you choose Original Medicare or a Medicare Advantage plan. The Medicare website includes a calculator to help you determine your Part B premium.

Monthly premiums for Medicare Advantage plans can range from popular $0 plans to a few hundred dollars.

You may want to consider the balance between the cost of the monthly premiums you pay and expenses like copays and coinsurance, to understand what you may pay in one year.

We're here for you and always happy to help, whether you are considering one of our plans or Original Medicare. At the end of the day, you need the plan that's best for you.

Call us, come to a Medicare educational seminar, or stop by a YourBlue Store location, and ask us whatever questions you have.

Or use our online plan recommendation tool. It's an easy way to narrow your choices within Blue CHiP for Medicare plans.