Original Medicare vs. Medicare Advantage: Apples and Oranges?

Original Medicare vs. Medicare Advantage: Apples and Oranges?

Sep 24 2019

Comparing your Medicare options doesn’t have to be a confusing ordeal. Know what’s covered and what isn’t under your plan.

When it comes to Medicare plans, you have options. Typically, when you turn 65, you become eligible for Original Medicare. While Original Medicare offers broad coverage, it doesn’t cover everything—and you might find that it doesn’t cover enough. Private insurers—Priority Health included—offer additional plans to help fill in those coverage gaps, including Medicare Advantage plans. But what’s the difference between Original Medicare and Medicare Advantage? Let’s take a closer look at their differences and how you can decide if a Medicare Advantage plan is right for you.

You can think of Original Medicare as a Medicare “starter pack.” Original Medicare is administered by the federal government and includes hospitalization (Part A) and medical service (Part B) coverage starting at age 65. Usually you’re eligible for Part A at no cost if you’ve paid into the Medicare system through your taxes for at least 10 years. If you’re a citizen or permanent resident of the United States, you’re eligible for Part B. There is also a monthly premium associated with Part B.

While Original Medicare covers about 80% of your medical expenses, many people need to purchase additional coverage for the remaining 20% that isn’t covered. For example, Original Medicare doesn’t include prescription drug coverage, long term care or routine dental and vision care. And before Original Medicare pays for any hospitalization costs or medical services, you’ll have to meet a deductible. That’s where a Medicare Advantage plan can help.

Medicare Advantage plans—or Medicare Part C—offer everything Original Medicare does, plus a lot more. These plans operate similar to that of an individual or employer HMO or PPO plan, which may feel most familiar to you. Medicare Advantage plans help lower your out-of-pocket costs with predictable copayments, smaller deductibles and out-of-pocket limits. In many cases, they may also include extras like prescription drug coverage, dental or a gym membership.

While Medicare Advantage plans certainly sound like an attractive option, those interested should consider what enrolling in one would mean for them financially. Advantage plans tend to be a great option for Medicare-eligible individuals who are looking to save money each month, but tend to have lower coverage needs. Typically with any health insurance plan, the lower the premium, the higher the deductible. Since an Advantage plan would entail a $0 premium, you could be paying more, especially factoring in aspects like prescription costs.

In addition to understanding the basics of an Advantage plan, you should also consider the benefits you’ll get and how to maximize them. Between your Evidence of Coverage (EOC), Virtual Care access and preventative care options, you have a plethora of resources under your plan.

If you’re feeling like a Medicare Advantage plan is the right choice for you, you have the option to change your plan during the annual enrollment period (AEP), which typically runs every year during the fall through early December. Further information on Medicare Advantage can be found on the official Medicare website. Learn more about Priority Health plans here.

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