Differences Between Medicare and Medicare Advantage plans

When it comes to healthcare coverage for seniors, Medicare is the go-to option. However, many people are unaware of the differences between traditional Medicare and Medicare Advantage plans. Understanding these differences is crucial for making informed decisions about healthcare coverage. In this blog post, we will explore the disparities between Medicare and Medicare Advantage plans, highlighting the pros and cons of each option. Furthermore, we will discuss essential factors to ponder when selecting between these options.


What is Medicare?

Medicare is a comprehensive federal health insurance program designed to provide coverage to individuals aged 65 and older, as well as those with disabilities or end-stage renal disease. This multifaceted program comprises different parts, namely A, B, C, and D, each catering to specific healthcare needs. Part A primarily offers hospital insurance, Part B covers medical services and doctor visits, Part C, also known as Medicare Advantage, combines Parts A and B with additional benefits through private insurers, and Part D addresses prescription drug coverage.

In addition to its core components, Medicare also plays a pivotal role in promoting preventive healthcare. It goes beyond merely addressing medical expenses by incorporating vital preventive services like vaccinations and screenings into its coverage. These preventive measures help to identify health issues at an early stage and can significantly contribute to better overall well-being and health outcomes for beneficiaries. This proactive approach underscores Medicare's commitment to not just treating illnesses but also preventing them whenever possible, making it an essential lifeline for millions of Americans seeking comprehensive healthcare coverage in their senior years and beyond.

Pros of Medicare

  • Medicare provides coverage for hospital stays, doctor visits, and some medical supplies.
  • It offers a wide network of healthcare providers, giving beneficiaries the freedom to choose their preferred doctors and hospitals.
  • Medicare is accepted nationwide, ensuring coverage even when traveling.
  • Medicare does not cut you stay short based on average healing and recovery of diagnosis like a medicare advantage plan does 

Cons of Medicare

  • Medicare does not cover all healthcare costs, leaving beneficiaries responsible for out-of-pocket expenses.
  • It does not include coverage for prescription drugs, which requires beneficiaries to enroll in a separate Part D plan.
  • Medicare does not typically cover services such as dental, vision, and hearing.

Medicare Advantage

What is Medicare Advantage?

Medicare Advantage, often referred to as Part C of the Medicare program, is an alternative way for eligible individuals to receive their Medicare benefits. Instead of the traditional fee-for-service approach provided by Medicare Parts A and B, Medicare Advantage plans are offered by private insurance companies approved by Medicare. These plans bundle together hospital insurance (Part A) and medical insurance (Part B), and often include additional benefits such as prescription drug coverage (Part D), vision, dental, and wellness programs. While Medicare Advantage plans offer the convenience of comprehensive coverage under a single plan, they may also have specific networks of healthcare providers and cost-sharing requirements that can vary from one plan to another. Medicare Advantage aims to provide beneficiaries with more choices and potentially lower out-of-pocket costs, making it a popular alternative for those seeking a more customized approach to their healthcare needs.

Pros of Medicare Advantage

  • Medicare Advantage plans often include additional benefits not covered by traditional Medicare, such as prescription drug coverage, dental, vision, and hearing services.
  • Many Medicare Advantage plans offer lower out-of-pocket costs compared to traditional Medicare.

Cons of Medicare Advantage

  • Medicare advantage plans are set up to save Medicare money. 
  • Medicare Advantage sets up average length of stay dates by diagnosis and can cut your services when you are still in need of them and does not take into account other health conditions.  
  • Medicare Advantage plans have a restricted network of healthcare providers, limiting the choice of doctors and hospitals.
  • Beneficiaries may need to obtain referrals from their primary care physician to see specialists.
  • Medicare Advantage plans may require prior authorization for certain medical procedures or treatments.


Understanding the differences between Medicare and Medicare Advantage plans is essential for seniors seeking healthcare coverage, especially those considering options like Pomeroy Skilled Nursing in Rochester. While Medicare offers a wide network of providers and flexibility, it does not cover all costs. On the other hand, Medicare Advantage plans provide additional benefits but come with restrictions on healthcare providers. By weighing the pros and cons of each option, individuals can make an informed decision that best suits their healthcare needs.


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Manda Ayoub

Manda is a nurse and a licensed nursing home Administrator in the state of Michigan. She has worked through all aspects of the post-acute healthcare industry, holding various positions including Infection Control Nurse, In-service Director, Quality Assurance Director, Risk Manager and a Licensed Nursing Home Administrator.