June 10

9 Differences between Medicare Advantage and Original Medicare

When it comes to Medicare and Medicare Advantage, not all things are created equal...

  • Medicare Advantage plans are typically network-based. Original Medicare is not.
  • Medicare advantage plans can require prior authorization for tests/procedures to be covered. Original Medicare does not.
  • Medicare Advantage plans typically cover annual eye exams. Original Medicare does for only those with eye issues.
  • Medicare Advantage plans typically cover routine footcare for everyone while Original Medicare only covers routine footcare for diabetics. 
  • Medicare Advantage plans covers an annual physical. Original Medicare only covers an annual wellness visit, which does not cover labs.
  • Original Medicare requires a 3-day minimum inpatient hospital stay before paying for skilled nursing facilities. Most Medicare Advantage plans waive the minimum stay requirement.
  • Original Medicare typically does not cover a beneficiary outside the US. Most Medicare Advantage plans will cover emergency care worldwide.
  • Original Medicare does not cover prescription drugs at retail pharmacies. Most Medicare Advantage plans do.
  • Original Medicare does not cover self-administered drugs while a patient is in observation. Most Medicare Advantage plans do.

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