Mrs. Wang can understand the general differences between Original Medicare and Medicare Advantage plans as follows:
- Coverage:
Original Medicare includes Part A (hospital care) and Part B (outpatient care). Prescription drug coverage (Part D) is not included and must be purchased separately. Medicare Advantage plans (Part C) cover everything Original Medicare does (Parts A and B) and almost always include Part D drug coverage as part of the plan
- Additional Benefits:
Medicare Advantage plans often provide extra benefits not covered by Original Medicare, such as dental, vision, and hearing care, as well as other supplemental benefits like gym memberships and transportation. About 97% of Medicare Advantage plans offer these additional benefits, whereas Original Medicare generally does not cover them
- Costs and Out-of-Pocket Limits:
Original Medicare has no maximum out-of-pocket limit, meaning beneficiaries may face ongoing cost-sharing such as 20% coinsurance for Part B services. Medicare Advantage plans have an annual maximum out-of-pocket limit (up to $9,350 in 2025), after which the plan pays 100% of covered services. However, Medicare Advantage copays and coinsurance vary depending on whether care is in-network or out-of-network
- Provider Networks and Restrictions:
Original Medicare allows beneficiaries to see any doctor or hospital that accepts Medicare nationwide, with no network restrictions. Medicare Advantage plans usually have provider networks, and seeing out-of-network providers may cost more. Also, Medicare Advantage plans often require prior authorizations and referrals more frequently than Original Medicare
- Eligibility for Supplemental Coverage:
Beneficiaries with Original Medicare can buy Medigap (supplemental) plans to help cover out-of-pocket costs, but Medigap plans are not available to those enrolled in Medicare Advantage
In summary, Medicare Advantage plans bundle Part A, Part B, and usually Part D, often add extra benefits, and limit out-of-pocket spending with an annual cap, but may restrict provider choice and require more prior authorizations. Original Medicare offers broader provider choice but lacks an out-of-pocket limit and additional benefits, requiring separate plans for drug coverage and supplemental insurance
