What is Medicare Advantage (Part C)?

How does Medicare Advantage differ from Original Medicare, and what benefits does it offer?

Medicare Advantage (also known as Medicare Part C) is an alternative way to receive your Medicare benefits. It differs from Original Medicare (Parts A and B) in several key ways, including coverage, costs, and additional benefits. Here’s a breakdown of the differences and benefits Medicare Advantage offers:

1. Coverage:

   • Original Medicare: Covers hospital services (Part A) and medical services (Part B), such as doctor visits and outpatient care. However, it does not include prescription drug coverage (Part D), vision, dental, hearing, or wellness programs.

   • Medicare Advantage: Combines Parts A and B into one plan and often includes additional benefits like prescription drug coverage (Part D), as well as coverage for services Original Medicare doesn’t cover, such as dental, vision, hearing, fitness programs, and wellness services.

2. Costs:

   • Original Medicare: With Original Medicare, you pay a deductible for Part A services and a monthly premium for Part B, along with 20% of the cost of most services. You may also want to add a Medigap (Medicare Supplement) policy to help cover out-of-pocket costs like deductibles and coinsurance.

   • Medicare Advantage: Typically, Medicare Advantage plans have a lower out-of-pocket cost structure than Original Medicare. Many plans include set copayments for doctor visits and services, and some offer $0 monthly premiums. However, you are still responsible for paying your Part B premium.

3. Network of Providers:

   • Original Medicare: You can visit any doctor or hospital nationwide that accepts Medicare, giving you a broad choice of providers.

   • Medicare Advantage: Most plans require you to use a network of doctors and hospitals, and you may need a referral to see a specialist. Some plans are HMO or PPO networks, which may limit your provider options to keep costs lower.

4. Prescription Drug Coverage:

   • Original Medicare: To get prescription drug coverage, you need to enroll in a separate Medicare Part D plan.

   • Medicare Advantage: Many Medicare Advantage plans include Part D prescription drug coverage bundled with the plan, so you don’t need to purchase a separate plan.

5. Additional Benefits:

   • Original Medicare: Does not cover extra services such as dental, vision, or hearing aids.

   • Medicare Advantage: Often includes extra benefits that Original Medicare does not offer, such as dental care, vision services, hearing aids, fitness memberships, and wellness programs.

6. Out-of-Pocket Maximum:

   • Original Medicare: There is no annual out-of-pocket limit with Original Medicare.

   • Medicare Advantage: Medicare Advantage plans have an annual out-of-pocket maximum, which limits how much you spend in a year on covered services. Once you reach this limit, the plan pays 100% of covered services for the rest of the year.

If you're trying to decide whether Medicare Advantage or Original Medicare is right for you, a Tsunami Advisor can help guide you through your options based on your healthcare needs and budget. Schedule an appointment here: Schedule an Appointment.