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Medicare Annual Enrollment ends soon! Deadline to enroll is Dec. 7th. 

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Original Medicare vs. Medicare Advantage?

Original Medicare is a good coverage option. But if you’re looking for more, a Medicare Advantage plan – also known as a Part C plan—comes with everything included in Original Medicare, plus prescription drug and other benefits.

Comparing Original Medicare and Medicare Advantage

  • Original Medicare includes Part A and Part B, which cover basic hospital and medical coverage.
  • Medicare Advantage (Part C) comes with Parts A and B, plus additional coverage not found in Original Medicare. This includes benefits like prescription drug coverage (Part D). Think of Medicare Advantage as an all-in-one health plan.

 

Here are a few differences between the two:

Original Medicare

Medicare Advantage

Who runs this program?

Federal government

Private insurance companies

What does it cover?

Medicare Parts A and B (hospital and doctor visits).

Medicare Parts A and B, plus routine dental, vision, and hearing care. Many plans include prescription drug (Part D) coverage.

Network

You can go to any doctor or hospital in the U.S. that accepts Medicare.

You’re generally required to use in-network doctors or hospitals. Your costs may be higher if you see an out-of-network provider.

Monthly premiums

Typically no cost for Medicare Part A if you and/or a spouse paid Medicare taxes. You’ll need to pay a Part B premium.

Many Medicare Advantage plans offer low or $0 monthly premiums. You must continue to pay your Part A ($0 for most people) and Part B premiums along with your Medicare Advantage premium.

Maximum out-of-pocket cost

No maximum out-of-pocket guarantee.

Yearly maximum out-of-pocket limit on costs.

Deductibles and coinsurance

Set deductibles.

Deductibles and copays vary depending on the Medicare Advantage plan.

Can I switch plans?

You may join, drop, or switch to another Medicare Advantage plan during the Annual Enrollment Period (AEP) – from October 15 to December 7 each year. Dropping Medicare Advantage automatically returns you to Original Medicare coverage. You may also be eligible for a Special Enrollment Period (SEP) if you have a qualifying life event, such as moving from your plan’s service area or losing employer coverage.

You may join, drop, or switch to another Medicare Advantage plan during the Annual Enrollment Period (AEP) – from October 15 to December 7 each year. Dropping Medicare Advantage automatically returns you to Original Medicare coverage. You may also be eligible for a Special Enrollment Period (SEP) if you have a qualifying life event, such as moving from your plan’s service area or losing employer coverage.

*Benefits vary based on plan and location.

Original Medicare

Who runs this program?

Federal government

What does it cover?

Medicare Parts A and B (hospital and doctor visits).

Network

You can go to any doctor or hospital in the U.S. that accepts Medicare.

Monthly premiums

Typically no cost for Medicare Part A if you and/or a spouse paid Medicare taxes. You’ll need to pay a Part B premium.

Maximum out-of-pocket cost

No maximum out-of-pocket guarantee.

Deductibles and coinsurance

Set deductibles.

Can I switch plans?

You may join, drop, or switch to another Medicare Advantage plan during the Annual Enrollment Period (AEP) – from October 15 to December 7 each year. Dropping Medicare Advantage automatically returns you to Original Medicare coverage. You may also be eligible for a Special Enrollment Period (SEP) if you have a qualifying life event, such as moving from your plan’s service area or losing employer coverage.

*Benefits vary based on plan and location.

Medicare Advantage

Who runs this program?

Private insurance companies

What does it cover?

Medicare Parts A and B, plus routine dental, vision, and hearing care. Many plans include prescription drug (Part D) coverage.

Network

You’re generally required to use in-network doctors or hospitals. Your costs may be higher if you see an out-of-network provider.

Monthly premiums

Many Medicare Advantage plans offer low or $0 monthly premiums. You must continue to pay your Part A ($0 for most people) and Part B premiums along with your Medicare Advantage premium.

Maximum out-of-pocket cost

Yearly maximum out-of-pocket limit on costs.

Deductibles and coinsurance

Deductibles and copays vary depending on the Medicare Advantage plan.

Can I switch plans?

You may join, drop, or switch to another Medicare Advantage plan during the Annual Enrollment Period (AEP) – from October 15 to December 7 each year. Dropping Medicare Advantage automatically returns you to Original Medicare coverage. You may also be eligible for a Special Enrollment Period (SEP) if you have a qualifying life event, such as moving from your plan’s service area or losing employer coverage.

*Benefits vary based on plan and location.

Medicare Part A helps cover:

  • Hospital stays (semi-private rooms) up to 60 days
  • Hospital meals
  • Nursing services
  • Intensive care services
  • Drugs, medical supplies and equipment used on the premises
  • Lab tests and X-rays taken while hospitalized
  • Surgery and recovery costs
  • Rehabilitation and therapy services
  • Part-time home nursing care

Medicare Part B helps cover:

  • Doctor visits
  • Vaccinations and flu shots
  • Health screenings and medical tests
  • Medical supplies
  • Ambulance services
  • Smoking cessation and other preventive healthcare programs

Medicare Part C includes:

  • Everything in Medicare Parts A and B
  • Coverage for dental, hearing, vision, and prescription drugs (Part D)
  • Extra programs to improve your overall health and well-being

What are additional benefits of Medicare Advantage vs Original Medicare?


In addition to everything included with Original Medicare, Medicare Advantage plans offer benefits such as:

Prescription drug coverage

 

Many Medicare Advantage plans include prescription drug (Part D) coverage. These plans are known as Medicare Advantage Prescription Drug (MAPD) plans.

Vision care


Eye health becomes more important as we age. Eye exams, glasses, and contacts are a part of many Medicare Advantage plans.

Transportation

 

Rides to health appointments1

Dental care

 

Many Medicare Advantage plans offer dental coverage for things like routine checkups and exams, cleanings, and dentures. They also cover unplanned dental procedures like root canals and crowns.

Hearing care

 

Original Medicare doesn't cover hearing aids, which can be expensive. Many Medicare Advantage plans provide hearing coverage that includes testing and medically required hearing aids.

Fitness program


Medicare Advantage plans also help you live a healthy lifestyle. Many plans include access to gym memberships, senior fitness programs like SilverSneakers®, and coaching to improve your well-being.

What about the difference in costs?

Original Medicare

  • Part A premiums are most likely free if you or your spouse worked and paid Medicare taxes.
  • Part B includes a premium and deductible.
  • Both of your Part B costs are based on your lifetime earnings, so beneficiaries who make less may pay less for Part B.

Medicare Advantage

  • Many plans have $0 premiums (you’ll still pay your Part B premium).
  • The costs vary depending on where you live.
  • On average, your monthly premiums are usually lower than what you may pay for Original Medicare.

Why is a Medicare Advantage plan right for me?


Having a Medicare Advantage plan with rich benefits can help you stay healthier as you age. A Wellpoint Medicare Advantage plan provides flexibility and lets you select a plan to best meet your needs.

Find plans in your area

Need help finding the right plan? Talk to a licensed agent:

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1 Transportation services are issued as one-way trips and provided on an annual basis. Benefits vary by plan.

 

Wellpoint, a Medicare Advantage organization with a Medicare Contract, offers HMO, HMO D-SNP, HMO C-SNP, HMO I-SNP, LPPO, and PDP plans.  Wellpoint HMO D-SNP plans additionally contract with state Medicaid programs. Enrollment in a Wellpoint health plan depends on contract renewal.