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Choosing Your Medicare Plan: Original Medicare vs. Medicare Advantage

PCF Senior Benefits Practice Leader Jason Milz offers a helpful guide to Original Medicare and Medicare Advantage.

When it comes to Medicare, the federal health insurance program for people aged 65 or older, as well as for certain younger individuals with specific health concerns, there are the two options most people are familiar with: Original Medicare Only (OMO) and Medicare Advantage (MA). Let’s compare these two options to help you make an informed decision that best suits your healthcare needs.

Understanding Original Medicare Only (OMO)

Original Medicare is the traditional Medicare program offered directly through the federal government. It has two parts:

  • Part A (hospital insurance): This covers inpatient hospital stays, care in a skilled nursing facility, hospice care and some home healthcare.
  • Part B (medical insurance): This covers certain doctors' services, outpatient care, medical supplies and preventive services.

With Original Medicare, you’re covered for any hospital or doctor that accepts Medicare, offering a wide range of choices for your healthcare providers. However, it doesn’t typically cover prescription drugs, and you might have to pay a deductible, monthly premiums and coinsurance for most services—though costs can vary. 

Exploring Medicare Advantage (MA)

Medicare Advantage Plans, also known as “Part C,” are an alternative to Original Medicare. These plans are offered by private insurance companies approved by Medicare. They include everything covered under Part A and Part B, and they may include additional benefits:

  • Prescription drug coverage (similar to Part D)
  • Routine care for vision, dental and hearing
  • Wellness programs and other added benefits

The costs for MA plans can vary in both premium costs and out-of-pocket expenses like copayments or coinsurance. Also, these plans usually have a network of doctors and hospitals you must use to be covered.

Comparing Original Medicare and Medicare Advantage: What's Best for You?

When it comes to choosing between Original Medicare Only (OMO) and Medicare Advantage (MA), understanding the key differences is crucial. There are some core aspects that set these two options apart: the healthcare providers you can access, the out-of-pocket costs you might incur, the additional benefits each plan offers and the overall flexibility and convenience. Each of these factors plays a significant role in determining which type of plan aligns best with your healthcare needs and lifestyle. 

Let's explore these differences to help you make a more informed and confident decision about your Medicare coverage.

1. Healthcare Providers

  • OMO: Offers the freedom to visit any doctor or hospital that accepts Medicare, providing a wide range of choices
  • MA: Generally, requires using healthcare providers within their specific network, which can limit your options but often ensures coordinated care

2. Out-of-Pocket Costs

  • OMO: Does not have a cap on out-of-pocket expenses, potentially leading to higher costs depending on your healthcare needs
  • MA: Features an annual limit on out-of-pocket expenses, offering a safeguard against excessive costs

3. Additional Benefits

  • OMO: Primarily covers hospital and medical insurance but often lacks coverage for services like dental, vision and hearing
  • MA: May include additional benefits not covered by Original Medicare, such as dental, vision, hearing and sometimes wellness programs

4. Flexibility and Convenience

  • OMO: Requires purchasing additional policies (like Medigap or Part D for prescription drugs) for more comprehensive coverage, adding complexity and sometimes cost
  • MA: Offers the convenience of having all your Medicare coverage under a single plan, simplifying management and paperwork

By comparing these aspects of Original Medicare and Medicare Advantage, you can better decide which plan suits your lifestyle and health needs. Whether you prioritize a broader choice of providers, cost predictability, additional benefits or convenience, your choice will impact your healthcare experience in the years to come.

Choosing What’s Right for You

Choosing between Original Medicare and Medicare Advantage depends on your individual health needs, budget and preferences:

  • Health needs: If you have specific health conditions, consider which plan offers the best coverage for your treatments.
  • Budget: Analyze the costs associated with each option—premiums, deductibles and out-of-pocket maximums.
  • Provider preference: If you have preferred doctors or hospitals, check if they’re covered under the plan you choose.
  • Flexibility: Remember, you have the option to switch plans during the Medicare Annual Enrollment Period from October 15 through December 7 if your needs change.

An Important Decision: Original Medicare or Medicare Advantage?

While Original Medicare may offer broader provider options and direct federal management, Medicare Advantage can provide additional benefits with potentially lower out-of-pocket costs but with network restrictions. We recommend evaluating your current health needs, financial situation and healthcare provider preferences to make the best choice.

If you’re still uncertain about which plan is right for you, consider consulting with a licensed insurance agent who knows Medicare. At PCF Senior Benefits, we’re always here to help you navigate these choices, ensuring you find the coverage that fits your life.

Deciding between Original Medicare and Medicare Advantage can be complex, but you don't have to navigate it alone. Visit to begin your informed healthcare journey with PCF Senior Benefits!

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