Medicare Minute: Choosing Between Original Medicare and Medicare Advantage

People with Medicare often wonder whether to choose Original Medicare or a Medicare Advantage Plan. Learn the key differences to help you choose the best option for your needs.

Original Medicare

The traditional program offered directly through the federal government.

• Includes Part A (inpatient coverage) and Part B (outpatient coverage)
• Red, white and blue insurance card to show your providers
• Taken by most doctors in the country
• Limits on how much doctors can charge if they accept Original Medicare

Medicare Advantage

Private plans that contract with and receive payment from the federal government to provide Medicare benefits.

• Also called MA plans, Medicare private health plans or Part C
• Insurance card from the specific plan’s company to show providers
• Must provide same benefits as Original Medicare, but can have different rules (like provider networks), costs and restrictions
• Can cover benefits that Original Medicare cannot

You may choose one option and later decide to try the other. Be aware that there are limitations on when you can make these changes. Your Medigap (supplement to Original Medicare) options may be more limited outside of the first 6 months that you’re enrolled in Medicare after the age of 65.

Click here to download a table that compares Original Medicare and Medicare Advantage by costs, Medigap supplement insurance, provider access, referrals, drug coverage, Medicare Advantage supplemental benefits, and Out-of-pocket limits.

Remember that there are several different kinds of Medicare Advantage plans. If you’re interested in joining a plan, speak to a plan representative to learn more.

Watch Out for Misleading Marketing

Health insurance companies try to reach people in various ways, like television commercials, radio ads, events, mailings, phone calls, and texts. The Centers for Medicare & Medicaid Services (CMS) has rules for how companies can sell Medicare Advantage plans and Part D plans. These rules protect Medicare beneficiaries from aggressive or misleading marketing. 

Before you enroll in a plan, make sure you understand:

• What the plan covers
• How it affects your Medicare benefits and other health benefits (like Medicaid or your retiree/union coverage)
• Whether your doctors are in-network
• Whether the plan covers the drugs you need

An agent or broker should never pressure or mislead you into joining a plan. They should also never offer gifts to sign up or say they were sent by Medicare or Social Security.  If you feel an insurance agent has pressured or misled you, you should save all their information. This might include:

• Agent’s business card
• Dates and times of phone calls
• Marketing handouts
• Recorded messages
• Emails

You should report this to your local Senior Medicare Patrol (SMP) or State Health Insurance Assistance Program (SHINE). Your SMP or SHINE Medicare counselors can help you review the concern and report it to CMS as a potential marketing violation. Contact information for your local SMP and SHINE teams by calling 866-413-5337 or emailing shineinfo@aaaswfl.org. 

Your local SHINE counselors can also help you seek a Special Enrollment Period (SEP) to switch plans if you are misled into a plan that does not cover the services you need.  

Who to contact for help:

• Call your State Health Insurance Assistance Program (SHINE) at 866-413-5337 to compare your Medicare coverage options.
• Go to www.Medicare.gov for online help comparing private plans in your area. You can enroll online or by calling 1-800-MEDICARE (633-4227).
• Contact a private plan directly before enrolling to confirm its coverage and rules.
• Call your Senior Medicare Patrol (SMP) if you experienced misleading marketing.