Medicare Advantage Plans vs. Original Medicare

Medicare Open Enrollment has arrived again — offering the choice between staying with Original Medicare or switching to a Medicare Advantage (Part C) plan. Both options offer vital health coverage, but there are key differences you should understand before making your decision. Let’s examine Original Medicare and Medicare Advantage Plans.

Original Medicare consists of Part A (hospital coverage) and Part B (medical coverage). You can see any doctor or use any hospital in the U.S. that accepts Medicare, and many people add a stand-alone Part D plan for prescription drugs and a Medigap (supplemental) policy to help cover deductibles and coinsurance. This flexibility can be critical if your health needs change or you require specialized or long-term care.

What is Medicare Advantage?

Medicare Advantage plans are provided by private insurers and usually combine Part A, Part B, and often Part D. Many plans include extra benefits like vision, hearing, dental, or fitness programs and may have lower initial costs. However, there’s a trade-off: most require you to use in-network providers, often need referrals to see specialists, and can change their networks during the year. Coverage for nursing home care or skilled rehab is especially limited, and out-of-network facilities might not be covered at all. It can also be difficult to return to Original Medicare later and still qualify for a Medigap (supplemental) policy without health underwriting, meaning you may not be able to regain the same level of financial protection if your health changes.

Review your options carefully

The bottom line: the “advantage” of extra benefits and predictable costs might be attractive, but limits on choice and additional care should be considered carefully. Before switching, review plan networks and long-term coverage needs to prevent surprises later.

Need assistance exploring your options?

Call Hurley Elder Care Law at 404-843-0121 for a referral to a trusted Medicare specialist or to schedule a meeting with one of our four elder law attorneys. Our team is Certified, Compassionate, Competent, and Experienced.