Original Medicare vs Medicare advantage

If you are starting to think about enrolling in Medicare, there are some important things you should know about your benefits. You’re likely eligible for Original Medicare, which includes Medicare Part A and Medicare Part B. It’s the minimum coverage required by the federal government and covers things like:

• Inpatient hospital stays
• Outpatient procedures
• Doctor visits
• Skilled nursing
• Medical supplies

Just sticking with Original Medicare, though, has some disadvantages — such as no limits on your out-of-pocket spending — even if you’ve met your deductible and your coinsurance (20% of the total bill) has kicked in. That means a hospital stay could still end up costing you thousands.

This is where Medicare Advantage, also called Medicare Part C, comes in to play. It includes everything that Original Medicare offers and a lot more — like prescription drug coverage, vision care, dental, hearing benefits, and coverage when you travel. And it limits your out-of-pocket spending.

Let’s take a closer look.

The Medicare Advantage (MA)

Medicare Advantage plans are health insurance plans that are offered through private companies like Highmark. These plans roll all your Medicare needs into one plan, so you only have to make one decision. Monthly premiums are typically low — with many plans having premiums as low as $0 per month — and they’re the same price for every person, regardless of age, health, or income. Medicare Advantage plans also give you control over your health care costs by capping your maximum out-of-pocket costs and protecting your savings.

Most Medicare Advantage plans are different, so be sure to pick one that has all the benefits you want or think you’ll need. Many of them include:

• Dental coverage – most plans cover basic care, such as exams and fillings, while some also cover more extensive care including root canals, crowns, and dentures.
• Eye care – most plans cover contacts and eyewear not covered by Original Medicare, which could save you a lot of out-of-pocket costs.
• Over-the-counter medications – paying out-of-pockets for cold medicine and vitamins can really add up. Many plans cover these expenses.
• Gym coverage – most plans offer fitness programs that cover the cost of gym memberships.
• Clinical care teams – when you need specialty care, some plans offer clinical care teams that can coordinate your care, manage expenses, and much more.
• Hearing aids – plans that include this feature help cut down your costs on exams and high-quality hearing aids, which could save you thousands of dollars.
• Travel care – all MA plans include worldwide emergency care and some MA plans even cover routine care if you travel often or for long periods of time. Gain peace of mind knowing both your emergency and routine care needs are covered worldwide.
• Chronic diseases – additional care and benefits for chronic diseases like diabetes.

Have questions?

Highmark Personal Medicare Advisors are happy to help — online, inperson, or over the phone.

Talk to an expert