Understanding Medicare
and Medicare Advantage

Original Medicare vs. Medicare Advantage

If you are new to Medicare, it is easy to become overwhelmed by the different options. Understanding the difference between Original Medicare and Medicare Advantage is essential. It is our goal to clear up any confusion that you may have. Below you will find a comparison of the two that may answer many of your questions.

Original Medicare (Parts A & B)
Medicare Advantage (Part C)
What It Is
Original Medicare (Parts A & B)

Original Medicare is offered by the federal government. It includes:

  • Part A (inpatient care in hospital, skilled nursing facility care, hospice, care, and home health care)
  • Part B (services from doctors and other healthcare providers, outpatient care, home health care, durable medical equipment, and many preventative services)
Medicare Advantage (Part C)

Also called Medicare Part C, Medicare Advantage is an “all-in-one” alternative to Original Medicare. These “bundled” plans include:

  • Part A (inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care)
  • Part B (services from doctors and other healthcare providers, outpatient care, home health care, durable medical equipment, and many preventative services
  • Usually Part D (prescription drug plan)
What it Covers
Original Medicare (Parts A & B)

Hospital and doctor visits

Medicare Advantage (Part C)

All Medicare Advantage plans provide all the benefits of Original Medicare, but most plans offer much more.

Doctors and Hospital
Original Medicare (Parts A & B)

You can use any doctor or hospital in the U.S. that takes Medicare

Medicare Advantage (Part C)

MA plans generally require you to use doctors and facilities that are in your plan’s network. If you see an out-of-network provider, your costs may be higher.

Maximum Out-of-Pocket Cost Guarantee
Original Medicare (Parts A & B)

There is no yearly limit on what you pay out of pocket

Medicare Advantage (Part C)

MA plans have a yearly limit on what you pay out-of-pocket for Medicare Part A and Medicare Part B covered services. Once you reach your plan’s maximum out-of-pocket amount, you will pay nothing for Part A and Part B covered services for the remainder of the year.

Cost
Original Medicare (Parts A & B)

For Part B covered services, you usually pay 20% of the Medicare approved amount AFTER you meet your deductible

Medicare Advantage (Part C)

Out of pocket costs vary. Some plans may have lower out-of-pocket costs for certain services.

Premium
Original Medicare (Parts A & B)

You do not usually pay a Part A premium if you or your spouse paid Medicare taxes for at least 10 years while working. You do pay a premium for Part B coverage. The standard monthly premium for 2021 is $148.50.

Medicare Advantage (Part C)

Many MA plans offer an affordable or $0 monthly plan premium. MA members must continue to pay their monthly Part B premium ($148.50 in 2021), along with any MA plan premium..

Deductibles and Coinsurance
Original Medicare (Parts A & B)

The 2021 Part A deductible for inpatient hospital coverage is $1,484.

The 2021 annual deductible for Part B medical coverage is $203.

Medicare Advantage (Part C)

Deductibles and copays vary depending on the MA plan. Many MA plans offer little or no deductible with their plans.

Prescription Drug Coverage
Original Medicare (Parts A & B)

Original Medicare does not include prescription drug coverage

Medicare Advantage (Part C)

Most MA plans include coverage for prescription drugs. It is part of the “all-in-one” benefits of the MA plan.

Eligibility Requirements

Original Medicare Eligibility Requirements

  • Age 65
  • Under 65 if you are disabled or have been diagnosed with End Stage Renal Disease (ESRD)

New Hanover Health Advantage Eligibility Requirements

  • You’re entitled to Medicare Part A and are enrolled in Medicare Part B
  • You live in New Hanover, Brunswick or Pender counties in North Carolina

When can you enroll in Medicare or a Medicare Advantage plan?

There are four distinct enrollment periods during which you can enroll in Original Medicare or a Medicare Advantage plan. Find out which one is right for you.

See Enrollment Periods