Original Medicare

Original Medicare includes Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance). Original Medicare covers things like inpatient hospital care, doctors’ services and tests, and preventive services. You pay for services and items as you get them. You must be lawfully present in the U.S. for Medicare to pay for Part A and Part B covered services

Medicare Advantage

Medicare Advantage, also known as Part C or MA, is a Medicare-approved health plan option that provides Part A, Part B, and usually Part D coverage. Private companies offer these plans, which are similar to HMOs and PPOs. 

Here are some things to know about Medicare Advantage:

• Coverage
• Medicare Advantage plans cover Part A (hospital insurance) and Part B (medical insurance). Most plans also include Part D, which is Medicare prescription drug coverage. Some plans may also offer additional benefits like dental, vision, hearing, and wellness programs. 
• Cost
• Medicare Advantage plans can have different out-of-pocket costs than Original Medicare. You may also have to pay an additional premium. The average premium for a Medicare Advantage plan in 2024 is projected to be $18.50 per month, but other costs like deductibles and copays may also apply. 
• Provider networks
• Medicare Advantage plans often limit you to using doctors and hospitals in their network. You may need a referral to see a specialist. If you want to use a doctor who isn't in the network, your costs may increase. 
• Rules
• Each Medicare Advantage plan has different rules for how you get services. These rules can change each year.

Medicare Supplement Plans (Medigap)

1. A Medigap policy is different from a Medicare Advantage Plan, and policies don’t cover prescription drugs. Medicare Advantage Plans bundle your Hospital (Part A), Medical (Part B), and usually drug coverage (Part D) into one plan. Most Medicare Advantage Plans also offer extra benefits that Medicare doesn’t cover, like vision, hearing, dental, and more.
2. A Medigap policy helps lower your share of costs for approved Part A and Part B services when you have Original Medicare. If you want drug coverage, you can join a Drug Plan (Part D) in addition to buying a Medigap policy.
3. Compare ways to get coverage
4. Medigap only works with Original Medicare. Medicare pays its share of the approved service, and then your Medigap policy helps pay your share. You can’t get a Medigap policy if you have a Medicare Advantage Plan, unless you switch back to Original Medicare.
5. Generally, you need Medicare Part A and Part B to buy and keep a policy.
6. The best time to get a policy is during your Medigap Open Enrollment Period. It’s the 6-month period that starts the month you turn 65 and you first have Medicare Part A and Part B. During this time, you can buy any Medigap policy sold in your state, even if you have health problems.
7. If you’re under 65, you may not be able to buy a Medigap policy, or you may have to pay more.
8. After your Medigap Open Enrollment Period ends, you may not be able to buy a policy. If you're able to buy one or want to switch policies later, it may cost more.
9. You may have Medigap protections, called guaranteed issue rights, in certain situations when insurance companies must offer you certain Medigap policies.
10. There are 10 standardized plans. Each plan offers different levels for how much of your costs they’ll pay for. They’re named by letter, like Plan A, and Plan B. Not all plans are offered in every state.
11. If you live in Massachusetts, Minnesota, or Wisconsin, your state offers different standardized plans.
12. You'll keep your policy, even if you have health problems, as long as you pay your Medigap policy and Part B premiums.

• Medicare Advantage plans combine Medicare Part A and B, and often include Part D prescription drug coverage. Medicare Supplement plans cover most or all of the out-of-pocket costs that Original Medicare doesn't cover. 

• Medicare Advantage plans require you to use in-network providers and facilities, which may limit your options. Medicare Supplement plans are accepted by any provider or facility that accepts Medicare. 

• Medicare Advantage plans may have low or zero-dollar premiums, but you may have higher out-of-pocket costs when receiving care. Medicare Supplement plans may have higher monthly premiums than Medicare Advantage plans. 

• Medicare Advantage plans aren't available everywhere, especially in rural areas. 

• You can't have both Medicare Advantage and Medicare Supplement plans at the same time. If you want to switch from Medicare Advantage to Original Medicare and buy a Medigap policy, you can contact your Medicare Advantage Plan to see if you can disenroll.