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Original Medicare or Medicare Advantage?

Understanding the differences between Original Medicare and Medicare Advantage is important to helping you choose the right coverage for your needs.

You’re probably aware that you may be eligible for certain medical benefits from the government when you turn 65. This program is known as "Original Medicare."

Medicare Advantage (or Part C) was launched in 1995 when the federal government created a way for private health care companies to sell new plans under a strict regulatory framework that combines both Part A (Hospital) and Part B (Doctor) coverage in a single plan.

All Medicare Advantage plans offer at least the same benefits as Medicare Parts A and B. That means if Original Medicare covers hospital care at a certain level, so will every Medicare Advantage plan on the market.

But the benefit of Medicare Advantage plans is that they offer more coverage than Original Medicare, and many also include prescription drug coverage.

Below is a short video that describes the key differences between Original Medicare and Medicare Advantage.

Original Medicare or Medicare Advantage – What’s the difference?

View Transcript

Choosing a Medicare plan can be very confusing. For example, what’s the difference between Original Medicare and Medicare Advantage plans?

Let’s take a closer look.

Original Medicare helps pay for hospital, skilled nursing and hospice care. It also pays for doctors’ visits and outpatient care, including physical and occupational therapy.

However, Original Medicare doesn’t cover expenses for dental, vision, hearing or prescription drugs.

What does Medicare Advantage cover?

Medicare Advantage offers all of the benefits of Original Medicare, and includes extra benefits such as dental, vision, hearing and wellness programs.

Many Medicare Advantage plans include reimbursement for gym or yoga studio memberships, activity trackers, weight management programs, and more.

Other benefits, like care managers to help coordinate care and in-home visits and preventive screenings, are also included.

Original Medicare doesn’t offer any of these benefits.

There are Medicare Advantage plans that also offer prescription drug coverage. One of the reasons these types of Medicare Advantage plans are so popular is because you don’t need to get separate prescription drug coverage.

Everything is included in one plan.

Many plans have low or no premiums. Plus, there is a maximum limit to your out-of-pocket costs, so if you become sick and have a long hospital stay, there is a limit on the amount you will be required to pay.

Original Medicare doesn’t provide a maximum limit.

Choosing Medicare Advantage will give you the coverage and support you need, all in one plan.

Once you understand the differences, you can decide if a Medicare Advantage plan is the right choice for you.

At Horizon Blue Cross Blue Shield of New Jersey, we want to help you understand your choices on your journey to better health.

ATTENTION: If you speak a language other than English, language assistance services, free of charge, are available to you. Call 1-800-365-2223 (TTY 711).

ATENCIÓN: Si habla otro idioma que no sea inglés, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-365-2223 (TTY 711).

Horizon Insurance Company (“HIC”) has a Medicare contract to offer HMO, HMO-POS, PPO and Part D Medicare plans, including group-Medicare Advantage plans and group Part D Prescription Drug plans. Enrollment in HIC Medicare products depends on contract renewal. Products are provided by HIC. Communications are issued by Horizon Blue Cross Blue Shield of New Jersey in its capacity as administrator of programs and provider relations for all its companies. Both are independent licensees of the Blue Cross and Blue Shield Association. The Blue Cross® and Blue Shield® names and symbols are registered marks of the Blue Cross and Blue Shield Association. The Horizon® name and symbols are registered marks of Horizon Blue Cross Blue Shield of New Jersey. © 2019 Horizon Blue Cross Blue Shield of New Jersey, Three Penn Plaza East, Newark, New Jersey 07105.

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