Medicare 101: What’s the difference between Original Medicare and Medicare Advantage?
Medicare can be a confusing topic, so if you are planning to initially enroll or review your options during the fall open enrollment, also known as the Annual Election Period (AEP), it’s important to explore all your choices.
Here are five key points you should know:
1. What is the difference between Original Medicare vs. Medicare Advantage?
There are two main ways to obtain Medicare coverage: Original Medicare or a Medicare Advantage plan. Use the chart below to help you understand your Medicare coverage choices:
2. What is the Medicare Annual Election Period (AEP)?
The Medicare AEP occurs every year from Oct. 15 to Dec. 7. During this time, individuals can change their Medicare health or Part D prescription drug coverage. This includes returning to Original Medicare or joining or switching to a Medicare Advantage plan. New coverage begins in January.
You should ask yourself three questions when considering your Medicare options:
- Does my current Medicare coverage allow me access to all the providers that are important to me?
- Are my prescription drug costs as reasonable as they can be?
- Do I currently have all the health care benefits that are most essential to me?
If answered “no” to any of these questions, you may want to consider exploring other Medicare options, including:
- Changing your Medicare Advantage or your Part D prescription drug coverage to provide you better coverage for your current needs.
- Returning to Original Medicare or joining or switching to a Medicare Advantage plan.
Consider the following if you want to select one of these plan types:
- MA plans offer one way to receive Medicare benefits through private insurance companies approved by Medicare.
- MA plans provide the same Medicare Part A and Part B coverage as Original Medicare and most plans bundle in prescription drug coverage.
- MA plans may cover additional benefits that Original Medicare does not cover.
- You continue to pay your Medicare Part B monthly premiums whether you enroll in a MA plan, cost plan or Original Medicare.
- MA plan premiums vary in cost and most have copays for each medical service received. In addition, these plans have a yearly limit on what you pay for medical services.
- In most cases, you will need to use doctors and services that are in the MA plan’s network.
- MA plans are not subject to the mandated benefit requirements under Wisconsin insurance law (In Wisconsin, some Medicare cost plans and Medicare supplements are required to cover the treatment of certain specific health conditions and certain types of health care providers even when Medicare does not cover these expenses).
3. When can I enroll in a Medicare Advantage plan?
You can enroll in a MA plan when you first become Medicare eligible during what’s called your Initial Enrollment Period (IEP). The IEP is a 7-month period that begins three months before you turn age 65, the month you turn 65 and ends the third month after your 65 birthday.
If you currently have Medicare Part A and B, you have the option to enroll during AEP or anytime under specific circumstances, if you qualify for a Special Enrollment Period.
4. What if I enroll in a Medicare Advantage plan and I don’t like it?
There are special trial rights available for people who join a MA plan when they are first eligible for Medicare, due to turning age 65. Individuals may drop their current MA plan and go back to Original Medicare anytime within the first 12 months of enrolling in a plan.
5. What are available Medicare resources?
Medicare enrollment can be complicated, but individual help is available to ensure you have the right coverage. Check out these available resources:
- If you are a resident of Illinois, visit advocatehealth.com/medicare.
- If you are a Wisconsin resident, visit aurora.org/medicare
- To view and compare 2025 available plans in your area, visit the Medicare plan finder at medicare.gov/plan-compare or call 1-800-MEDICARE after October 1.
Maureen Centeno is a managed health engagement specialist at Advocate Health Care and Aurora Health Care.
