Original Medicare vs. Medicare Advantage Plans

​If you choose coverage under the traditional fee-for-service Medicare program, you can generally get care from any doctor or hospital you want and receive coverage for your care anywhere in the country. However, traditional Medicare has high cost-sharing requirements and does not currently cover the costs of certain services. To help pay for uncovered benefits and to help with Medicare's cost-sharing requirements, many people in the traditional Medicare program have supplemental insurance, known as Medicare Supplements or Medigap Plans (these supplemental insurance plans fill in gaps that Medicare does not cover but unlike Medicare Part C and Part D, these plans are not part of the government Medicare program).

• The Original Medicare Plan – This is a fee-for-service plan that covers many health care services and certain drugs. You can go to any doctor or hospital that accepts Medicare. When you get your health care, you use your red, white, and blue Medicare card.

The Original Medicare Plan pays for many health care services and supplies, but it doesn’t pay all of your health care costs. There are costs that you must pay, like coinsurance, copayments, and deductibles. These costs are called “gaps” in Medicare coverage. You might want to consider buying a Medigap or Medicare Supplement policy to cover these gaps in Medicare coverage. You can also add prescription drug coverage by joining a Medicare Prescription Drug Plan.

• Medicare Advantage Plans are available in many areas. If you have one of these plans, you don’t need a Medigap policy. These plans include:
  • Health Maintenance Organizations (HMO)
  • Preferred Provider Organizations (PPO)
  • Private Fee-for-Service (PFFS) Plans
  • Medical Savings Accounts (MSA)
  • Special Needs Plans (SNP)

These plans may cover more services and have lower out-of-pocket costs than the Original Medicare Plan. Some plans cover prescription drugs (these plans are known as, MA-PD for Medicare Advantage-Part D). In some plans, like HMOs, you may only be able to see certain doctors or go to certain hospitals to get covered services.

from Medicare.gov, Medicare Options Compare (2016) & Medicare.gov,Medicare Plan Choices Overview (2016)