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Understand How Original Medicare and Medicare Advantage Plans Differ Just in Time for the Medicare Annual Enrollment Period

Confused about the difference between Original Medicare and Medicare Advantage? Understanding these health insurance programs is especially important around the Medicare Annual Enrollment Period, when you have a chance to enroll in Medicare plans for the first time or change your coverage.

Who offers them?

Original Medicare—Parts A and B—is the healthcare offered through the federal Medicare program administered by the Centers for Medicare and Medicaid Services (CMS).

Medicare Advantage Plans are offered by private health insurance companies that have contracted with the federal government. These plans are approved to provide coverage for Medicare beneficiaries, but are separate from the government program.

What’s covered?

Original Medicare offers coverage for emergency, preventative, and medically necessary services and supplies. That means a number of important services aren’t covered.

Medicare Advantage Plans include the coverage offered under Original Medicare, and typically offer additional benefits as well, like vision, dental, hearing, fitness, and wellness. Some Medicare Advantage Plans may even offer these additional benefits with no additional premiums.

Is there a network?

Original Medicare doesn’t have a network of covered providers. Most providers accept Medicare, although you can always ask before receiving coverage to be certain.

Medicare Advantage Plans typically have a network of providers that provide covered services at a lower cost.

Is Prescription Drug Coverage included?

Original Medicare doesn’t include any coverage for prescription drugs, which are a critical element of healthcare for many beneficiaries. So much so that you’ll face additional fees for not having prescription drug coverage, which can be obtained through Medicare Part D Plans or Medicare Advantage Plans.

Not all Medicare Advantage Plans include prescription drug coverage, but the ones that do allow you to conveniently bundle your Parts A, B, and D coverage, often with additional benefits as well. These plans are sometimes abbreviated as MAPD.

Two Simple Ways to Enroll During the Medicare Annual Enrollment Period

You’ll want to know exactly what you need and what’s covered before the Medicare Annual Enrollment Period. The good news is you don’t have to do it alone. Call 1-800-991-4407 / TTY 711 for your no-cost personalized consultation. Our Medicare Advocates are available from 10 a.m. to 9 p.m. Eastern, Monday to Friday.

You can also find, compare, and enroll in Medicare Advantage Plans through the Medicare Online Enrollment Portal. Search by zip code, select multiple plans to easily compare costs and benefits, and enroll online when you find the plan that’s right for you!