Original Medicare or Medicare Advantage: 5 Questions to Help You Choose

When you qualify for Medicare, you can choose to get your benefits through Original Medicare or through a Medicare Advantage plan, but how do you know which program is right for you? If you’re considering your options, ask yourself the following questions. 

1. Do you prefer to have a limit to your annual medical expenses? 

When you have Original Medicare, you’ll be responsible for sharing the costs of your care. Depending on the services you need and how frequently you need care, your costs can add up. Medicare Advantage plans, on the other hand, have an annual maximum out-of-pocket limit. Once you’ve paid this amount, you will not have to pay for any covered services you require for the remainder of the year. In 2022, the maximum out of pocket is $7,550 but some Medicare Advantage plans may offer lower limits. 

• Do you want to see specific doctors or specialists?

When you have Original Medicare, you can see any doctor who accepts assignment. This means that the doctor or specialist has agreed to be paid the Medicare-approved amount for services. Depending on the type of Medicare Advantage plan you choose, you may have to visit doctors and specialists within the plan’s network of providers. If you’re choosing between Medicare Advantage plans, you may want to check if your preferred doctor is participating in that plan.

• Would you prefer to have all your benefits under one plan?

When you have Original Medicare, you’ll have access to Part A and Part B. If you want to get prescription drug coverage, you’ll have to enroll in a stand-alone Prescription Drug Plan (PDP). You might also consider enrolling in separate vision and dental care coverage, as well. Medicare Advantage (MA) plans will include the same Part A and Part B benefits as Original Medicare, but most plans include additional coverage. These additional benefits may include prescription drug coverage, routine dental and vision care, hearing exams, gym memberships, over-the-counter allowances, and/or more. MA plans are offered by private insurance companies, so the benefits and costs can vary. Some people may appreciate the convenience of having all their coverage included within a single plan. 

• Do you want to see a specialist without a referral? 

Under Original Medicare, you can visit any specialist who accepts assignment without a referral. When you’re enrolled in certain Medicare Advantage plans, like an HMO, you may need to get a referral from your primary care physician before seeing a specialist. If you choose a PPO plan, you may be able to go to a specialist without a referral and even go out of the plan’s network for a higher copayment.  

• Do you travel frequently outside of the country?

Original Medicare does not cover care outside of the United States. Some Original Medicare recipients choose to purchase a Medicare Supplement, or Medigap, plan that offers coverage for emergency medical care while you’re traveling abroad. Medicare Advantage plans generally don’t cover care outside the country, but may include some additional coverage for emergency or urgent care you need while you travel. (Please note, you can’t have both a Medicare Advantage plan and Medigap. Medigap is only an option for recipients of Original Medicare.)