Medicare Advantage vs. Original Medicare: What Matters Clinically

When patients ask “Which is better?”, we reframe it: Which fits your health, budget, and access needs? Here’s a neutral, doctor‑led comparison.

Access to doctors & hospitals

• Original Medicare (OM): See any provider that accepts Medicare—no networks.

• Medicare Advantage (MA): Private plans with networks (HMO/PPO); some require PCP referrals and prior authorization for certain services. Medicare+2Medicare+2

Costs & protections

• MA: Has an annual in‑network MOOP—once you hit it, covered in‑network services are $0 for the rest of the year.

• OM: No MOOP; many add Medigap to limit 20% coinsurance; drug coverage is via stand‑alone Part D. Medicare

Medications

• OM + Part D: Choose a stand‑alone drug plan and compare formularies/tiering in Plan Finder.

• MA‑PD: Drug coverage is usually included; still compare formularies & pharmacies. Medicare

Extras & care coordination

• MA plans often include extras (dental/vision/hearing) and can coordinate care tightly—helpful for some, restrictive for others. Rules vary by plan. Medicare

A practical way to decide

1. List your doctors, hospitals, and meds.

2. Compare OM+Part D vs MA in Plan Finder, focusing on access and total yearly cost. Medicare

3. If you’re considering MA, check HMO vs PPO differences (PCP, referrals, out‑of‑network options). Medicare

Ask about the $2,000 Part D cap (2025) and whether MPPP helps your monthly budget. CMS National Training Program+1

 We’ll walk you through the trade‑offs based on your conditions and meds.

Call 559‑369‑7787

Resources: Compare OM vs MA; “Understanding MA Plans”; Your Medicare Options. Medicare+2Medicare+2

We don’t sell insurance. We provide medical care and education. For unbiased plan counseling, contact HICAP/SHIP Fresno‑Madera at 559‑224‑9117. Valley CRC