How does Original Medicare differ from Medicare Advantage?

Original Medicare is a fee-for-service program, which means that beneficiaries can see any doctor or specialist who accepts Medicare and are billed based on the services they receive. This flexibility allows enrollees complete freedom in choosing their healthcare providers without needing referrals. Medicare pays for a portion of the costs, and beneficiaries often have to pay deductibles and coinsurance.

On the other hand, Medicare Advantage serves as an alternative health plan provided through private insurers. These plans often incorporate additional benefits beyond Original Medicare, such as vision and dental coverage, and typically require beneficiaries to choose from a network of doctors and may require referrals for specialists. The structure is more like managed care, often utilizing health maintenance organizations (HMOs) or preferred provider organizations (PPOs).

This distinction highlights how Original Medicare places a strong emphasis on beneficiary choice and flexibility, while Medicare Advantage offers a structured plan approach that may include additional benefits but typically involves more restrictions such as network limitations and potential prior authorization requirements.