Original Medicare vs. Medicare Advantage:

You can get your health-care coverage from Medicare in one of two ways:

  1. Through Original Medicare (Parts A and B), OR
  2. Through a health plan sponsored by a private company.  (These are sometimes called Medicare Advantage plans.) 

Original Medicare:

Original Medicare is sometimes called "fee for service" Medicare. You can go to any doctor or hospital that takes Medicare patients.  You usually pay a deductible and part of the cost of the services you get.

Medicare determines what health-care providers can charge for the services Medicare covers.

If you are in Original Medicare and want prescription drug coverage through Medicare, you would need to join a prescription drug plan.

Medicare Health Plans:

If you are enrolled in a Medicare health plan, you still have Medicare Parts A and B, but you get your health-care services through a private plan that has a contract with Medicare.  You pay your usual Part B premium, plus any additional premium that the plan may charge. 

There are different types of Medicare health plans, such as these:

  • Health Maintenance Organizations (HMOs).
  • Preferred Provider Organizations (PPOs).
  • Private Fee-for-Service plans (PFFS).
  • Special Needs Plans (SNPs).
  • Medical Savings Accounts.  

Generally, these plans cover all the same things as Medicare Part A and B. These plans also usually cover prescription drugs.

They usually require people to use providers (like doctors, hospitals, and pharmacies) that are part of their network.  Using providers outside your plan’s network will cost you more money.  These plans also may cover services that Original Medicare does not pay for, like vision or hearing care.

For additional information about Medicare health plans in your area, call 1-800-MEDICARE or visit the Medicare website.

NEXT: What is Covered

Information on this web site was compiled from approved materials of the Centers for Medicare and Medicaid Services.