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Medicare Advantage Plans vs. Original Medicare: Let’s Discuss the Benefits

By Lindsay Malzone February 09, 2021 Health and Fitness

Medicare Advantage plans, also known as Part C, must include everything Original Medicare (Parts A and B) offers. Additionally, these plans provide a variety of benefits that Original Medicare lacks.

Contrary to what many believe, Medicare isn’t free. Although you pay into the program for years, you’re still responsible for monthly premiums, as well as deductibles and copayments. Regardless, there are many aspects of health care that traditional Medicare doesn’t cover.

If the idea of a single health care plan with coverage for multiple aspects of your health appeals to you, an Advantage plan could be the right choice.

Prescription Drugs

The majority of Advantage plans include prescription drug coverage. If you stick to Medicare Parts A and B, whether or not you choose a Supplement plan (also known as Medigap), you’ll need to get prescription drug coverage separately. This comes in the form of Part D plans.

Whether or not you’re currently taking any prescription drugs, it’s wise to enroll in a Part D or Advantage plan with prescription drug coverage as soon as possible to avoid penalties. However, you can delay enrollment if you have creditable prescription drug coverage, such as through an employer with more than 20 employees.

You’ll want to make sure the formulary of your plan includes the prescriptions that you take. Advantage plans simplify your coverage by consolidating inpatient (Part A) and outpatient (Part B) coverage with prescription drug coverage. You’ll only need one card for your medical and drug insurance on most Advantage plans.

Dental Coverage

Original Medicare offers minimal coverage for dental care. In fact, it only pays for hospital costs when you have a dental emergency or complicated procedure. Medicare doesn’t pay for routine care. Yet, many Advantage plans include dental coverage.

Beneficiaries who don’t enroll in Advantage plans must purchase standalone dental plans if they want coverage for their dental care. If you don’t have dental coverage through an Advantage or standalone plan, you will pay 100% for cleanings, fillings, dentures, tooth extractions, and most other dental services. Medicare does not pay for any of these.

It’s essential to research multiple Advantage plans to make sure you choose one that will pay for the dental care you require. Also, make sure the dentists in your network are convenient to your location.

Vision Coverage

Similar to dental services, vision care through Original Medicare is sparse. Yet, many Advantage plans include this benefit.

Original Medicare does not pay for routine eye exams, but it can cover cataract surgery and treatment for glaucoma and detached retinas. If you need glasses, Part B will only pay for them if you have had cataract surgery. Part B will also only cover an annual eye exam if you have vision issues related to diabetes or glaucoma.

Many Advantage plans that include vision coverage pay for the routine eye exams and glasses or contact lenses you need. Keep in mind that you could be responsible for copayments and will probably need to stay within a network.

Hearing Coverage

Often, when we get older, our sense of hearing starts to suffer. Therefore, we need hearing exams and hearing aids. Original Medicare doesn’t cover this, as when Medicare was established, Congress noted that the cost for hearing aids was relatively low. Part B will pay for cochlear implants when medically necessary, but that is the extent of Original Medicare’s hearing benefits.

In addition to dental and vision, some Advantage plans include hearing benefits. To find out more about what hearing benefits an Advantage plan covers, contact the plan or work with an agent.

Also, make sure there is a reputable audiologist in the plan’s network in a convenient location for you. If not, and you need to travel farther to see a specialist within your plan, it might not be the best choice for you. 

Free Gym Membership

Some Advantage plans might include a free gym membership or another fitness program as an added benefit. Original Medicare doesn’t cover this benefit, but Medigap plans might provide similar coverage, such as through SilverSneakers. If you are interested in this benefit, you will need to see if any plans in your area provide it.

What to Consider Before Selecting an Advantage Plan

There are a few things to consider before selecting an Advantage plan for the extra benefits. Likely similar to your employer coverage, Advantage plans are usually PPO or HMO plans. Thus, they involve networks, and receiving care from a practitioner outside your network can mean higher out-of-pocket costs. Finding a plan whose network includes your preferred providers is the ideal situation.

Also, note that you need to enroll in Original Medicare before you select an Advantage plan. Monthly premiums for Advantage plans are low – sometimes zero dollars – but you’ll still need to pay applicable premiums for Original Medicare.

Advantage plans are best for individuals who do not need to visit doctors frequently and find Medigap premiums too steep for their budgets. If you find an Advantage plan that includes your preferred providers and the extra benefits you seek, it could be an excellent fit for you! The best step you can take is to speak to an agent and research plans.

Are you on employer health coverage or do you have a Medicare plan? Have you chosen to go the Advantage plans route? Which coverage options are the most important to you? Where do you seek advice when you have question concerning Medicare options?

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The Author

Lindsay Malzone is the Medicare expert for Medigap.com. She has been working in the Medicare space since 2017. Lindsay has a passion for sharing her expertise on Medicare to beneficiaries so they can be better prepared for healthcare costs after retirement. Her YouTube channel features various videos that help Medicare beneficiaries discover all their options.

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