Compare your Medicare coverage options

In the months leading up to Medicare enrollment, you should decide whether you want stick with only Original Medicare (Parts A & B) or if you want to enroll in a Medicare Advantage plan (Part C). The decision can be confusing, but it doesn’t need to be.

Original Medicare is the main building block of health care for American seniors, providing basic hospital and medical coverage through the Federal government. In 2014, more than 53.8 million people were enrolled in Medicare, according to the Centers for Medicare & Medicaid Services.

A Medicare Advantage plan is a form of private health insurance that provides at least the same health care coverage as Original Medicare, but plans may go beyond that to include additional benefits like dental, vision, and prescription drug coverage. In 2014, approximately 15.7 million Medicare enrollees were enrolled in a Medicare Advantage plan, according to the Kaiser Family Foundation. You first must enroll in Original Medicare before you enroll in a Medicare Advantage plan.

The following table shows how Original Medicare compares with a Medicare Advantage plan:

Original Medicare only Original Medicare + Medicare Advantage plan
Summary You get basic hospital and medical coverage from the government.

You pay standard deductibles, co-payments, and extra costs for that coverage.
You get the same basic hospital and medical coverage as Original Medicare, but it’s provided by private insurers. Most plans also include additional benefits.

Plans may have network restrictions and different deductibles, co-payments, and other out-of-pocket costs that you may have to pay.
Providers Benefits are paid by the Federal government. Benefits are paid by private insurance companies that get reimbursed by the Federal government.
Popularity More than 53.8 million enrollees in Medicare Part A and/or B in 2014 About 15.7 million enrollees in 2014
Eligibility You must be at least 65 and a U.S. citizen or permanent legal resident.

If you are under 65, you may qualify if you have a disability or serious disease such as End Stage Renal Disease (ESRD) and Amyotrophic Lateral Sclerosis (ALS).
You must be enrolled in Original Medicare.

You must live within a Medicare Advantage plan’s service area. Most plans are not offered to those with ESRD.

You cannot have a Medicare Advantage plan and a Medicare Supplement insurance policy at the same time.
Plan parts Medicare Parts A and B Medicare Parts A, B, and C
Benefits Original Medicare provides hospital and medical insurance benefits, which are standard for all enrollees.

If you need Medicare prescription drug coverage, you can enroll in a Part D plan.
All plans provide the same hospital and medical insurance benefits as Original Medicare. Different plans also offer additional benefits.

Many plans include prescription drug coverage. Some plans offer coverage for vision, hearing, dental, and wellness programs.
Premiums Part A is usually free. If not, it costs up to $426 each month.

Part B has a monthly premium of at least $105.
Original Medicare premium + Medicare Advantage plan premium

Medicare Advantage plan premiums differ depending on which plan you enroll in.

You must continue to pay your Part B premium.

Some Medicare Advantage plans include a Part B premium refund.
Extra costs
  • Part A deductible
  • Part A co-insurance for hospital, hospice, and skilled nursing care
  • Part B deductible
  • 20% co-insurance for Part B medical services
  • Part B excess charges
  • First 3 pints of blood
  • All costs for non-medically necessary care
Depends on which plan you buy.
Who accepts it? Any doctor or hospital that accepts Original Medicare. It depends on the policy. Some plans limit coverage to in-network providers and facilities. Other plans are more flexible.
Prescription coverage You must add Medicare Part D to get drug coverage. Drug coverage may be included in your Medicare Advantage plan. If not, you may be able to add Medicare Part D drug coverage.
Renewal Renewed each year as long as premiums are paid. Medicare Advantage plans can change yearly. You will remain in the plan each year unless you elect to disenroll and/or enroll in another plan.