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Original Medicare vs Medicare Advantage Benefits Compared
Learn the differences between Medicare Advantage and Original Medicare, and how Medicare Advantage can save you money.
Medicare AdvantageMedicare
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Medicare Advantage and Original Medicare have a lot in common, but there are some major differences worth noting. Since there are pros and cons to each plan, choosing between the two can seem daunting. We covered the differences in detail in our Medicare 101 starter guide (opens in new tab), but if you’re still on the fence about whether you should enroll in Original Medicare or a Medicare Advantage plan (opens in new tab), here are a few more things to keep in mind. Spoiler alert: Medicare Advantage has four key features that can help save you a lot of money.
The 4 big differences between Original Medicare and Medicare Advantage benefits
1. The MOOP
The maximum out-of-pocket limit, or MOOP, is the most money you’ll be required to pay for covered health care within a calendar year. Medicare Advantage plans have a set maximum out-of-pocket limit and Original Medicare plans don’t.
One way to think of a MOOP is that it acts as a safety net that protects you in the event you get some steep medical bills you weren’t planning on. Once you hit your MOOP limit, your insurance company pays for your covered health care services. Original Medicare doesn’t limit your out-of-pocket spending, so you could be on the hook for thousands of dollars if you need complex care.
Coinsurance (opens in new tab) is the percentage you’ll need to pay for covered health services, and this amount varies based on the total cost of the service you’ll receive. So an office visit will require a smaller amount of coinsurance than a complicated surgical procedure.
Original Medicare plans typically charge members 20% coinsurance, which means they are responsible for paying 20% of the total bill. Again, this may not be a lot for an office visit, but the prices can get high very quickly for complicated procedures, chronic illnesses, and emergencies.
The big difference here is that Medicare Advantage plans give members an opportunity to plan ahead, because they typically have set dollar amounts for most services. This way members can anticipate the costs of services and procedures, which makes financial forecasting a whole lot easier.
3. Extra benefits and perks
Some Medicare Advantage plans include benefits like dental and vision, which can help cover costs for routine dental care and eyeglasses. Other extra benefits include hearing aids and an allowance for over-the-counter items like pain relievers and personal care products.
Some plans may also offer wellness benefits and perks, like memberships to fitness facilities or programs that reward physical activity, which can be a handy way to earn some gift cards. For a deeper dive into these benefits and perks, you can check out The value of supplemental benefits (opens in new tab).
4. Prescription drug coverage
Another big distinction between Medicare Advantage and Original Medicare is prescription drug (opens in new tab) coverage. Most Medicare Advantage plans include prescription coverage, while Original Medicare requires members to buy a separate Part D prescription plan.
Some Medicare Advantage plans offer prescription delivery as well, but these benefits (as well as the drug formulary) vary by plan.
What are the advantages and disadvantages of Medicare Advantage Plans: A comparison
So how do these features stack up? Here’s a recap of the differences we’ve covered, as well as some more details about cost and coverage.
Original Medicare vs Medicare Advantage Comparison Chart
After considering the differences between Original Medicare and Medicare Advantage benefits, hopefully you have a better idea of which plan works best for your specific needs. It all comes down to what you value—if you want the financial protection of a MOOP and set costs for procedures, as well as prescription benefits and extra benefits like dental and vision all rolled into one plan, Medicare Advantage may be a good idea. Or, if your priority is having a flexible network of health care providers, then Original Medicare might make more sense.
