Medicare vs Medicare Advantage: Here are some of the differences

The 2021 Medicare annual Open Enrollment Period ends Dec. 7, and some have asked what’s the difference between Medicare and Medicare Advantage?

What they cover

Traditional Medicare covers hospital and doctors’ visits, but not things such as dental, hearing or vision.

Prescription coverage is also very limited.

To fill in the coverage holes, many get what’s called a Medigap Plan and a prescription drug plan.

Medicare Advantage tries to simplify coverage by providing a one-stop shop. It covers hospital and doctors’ visits just like Medicare, but throws in what Medicare doesn’t cover, including dental, hearing, vision and prescription coverage.

MORE: Understanding Medicare Advantage Plans

“With a Medicare Advantage Plan, you want to look at what are those extra added things that are covered? Am I going to use those?” said Jon Hess, a medical billing advocate and founder of Athos Health.

Hess said, sometimes, that might also include a gym membership.

What about cost?

Hess says, if you’re healthy and don’t take prescriptions, Medicare is likely cheaper because the premium is cheaper. But if you have chronic illness and are on multiple prescriptions, Medicare Advantage might make more sense because there is an out-of-pocket cap.

“At some point, if you’re really, really sick, you have a lot of issues, Medicare Advantage would be cheaper for you because there’s going to be a cap,” Hess said.

Cost is subjective and the right choice depends on your individual circumstances and yearly expenses. To compare costs more closely, use the out-of-pocket cost estimator on Medicare.gov. Before making any changes to your plan, consult a professional.

The Network

But the game-changer for most is the network.

Medicare doesn’t have a network. You can go to any doctor as long as they accept Medicare. Medicare Advantage has a network, so you can only see doctors on their plan. Otherwise, it’s going to cost you.

“Let’s say you split your time between Florida and Boston, well, if you buy a plan in Florida, a lot of doctors and hospitals in Boston won’t be covered,” Hess said. “You’ll be out of network.”

If you have health care questions you want answered, send us an email at [email protected].

Writer:Jack Lowenstein
Do you see a typo or an error? Let us know.
SHARE