Original Medicare vs. Medicare Advantage

You can go to any doctor that accepts Medicare

  • In most cases, you’ll need to use doctors who are in the plan’s network (for non-emergency or non-urgent care). Ask your doctor if they participate in any Medicare Advantage Plans
  • In most cases you don’t need a referral to see a specialist.
  • You may need to get a referral to see a specialist
  • For Part B-covered services, you usually pay 20% of the Medicare approved
  • amount after you meet your deductible.
  • Out-of-pocket costs vary—some plans have low or no out-of-pocket costs

Original Medicare vs Medicare Advantage

  • You pay a premium (monthly payment) for Part B. If you choose to
  • buy prescription drug coverage, you’ll pay that premium separately.
  • You may pay a premium for the plan (most include prescription
  • drug coverage) and a premium for Part B. Some plans have a $0
  • premium or will help pay all or part of your Part B premium.
  • There’s no yearly limit on what you pay out-of-pocket.
  • Plans have a yearly limit on what you pay out-of-pocket for Medicare
  • Part A and B covered services. Once you reach your plan’s limit, you’ll
  • pay nothing for Part A- and Part Bcovered services for the rest of the
  • year.
  • You can buy supplemental coverage to help pay your out-of-pocket costs
  • (like your deductible and 20% coinsurance). You can’t buy or use separate
  • supplemental coverage—but some plans have lower out-of-pocket costs
  • than Original Medicare


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