How Medicare Advantage Compares to Other Medicare Add-Ons

Different Medicare options

With all the Medicare options out there, understanding how they differ is important. For starters, the different types of Medicare plans include:

1. Original Medicare (Parts A and B)
2. Medicare Advantage (Part C)
3. Part D prescription coverage
4. Medigap
5. Dual-Eligible Special Needs Plan (D-SNP)

1. Original Medicare coverage

Original Medicare covers your healthcare basics in two parts. Part A coverage includes hospital stays and most inpatient care. Part B provides doctor visits, outpatient services and preventive care.

This option does provide the flexibility to see any provider who accepts Medicare. You'll typically be responsible for about 20% of costs after Medicare pays its share. And there's no annual out-of-pocket limit. Original Medicare also doesn't include prescription drug coverage or extra benefits like dental, vision or hearing.

For many people, Original Medicare takes care of most of their daily medical needs. However, if you need more coverage — select prescriptions, dental care, vision care, or hearing aids — you would have to add that to your plan.

2. Original Medicare plus Part D coverage

This builds on Original Medicare by adding a separate Part D plan to help cover prescription drug costs. Part D plans include a list of covered medications — called a formulary — and can help lower the cost of both generic and brand-name prescriptions.

Adding Part D to Medicare is a good choice for those who take maintenance medications and want more pharmacy options for their routine prescriptions. However, Part D doesn't include extra benefits like dental or vision coverage. It's also important to enroll in Part D when you're first eligible. Delaying enrollment may result in a late enrollment penalty.

Starting in 2027, Highmark will no longer offer stand-alone Part D plans.

3. Original Medicare plus Part D and Medigap coverage

This add-on offers the same coverage and benefits as Original Medicare and Original Medicare plus Part D, but includes Medigap. While Medigap doesn't provide additional benefits, it helps pay for the remaining costs — such as deductibles, copayments and coinsurance — Original Medicare doesn't cover.

And although you may have a larger monthly premium with Medigap, you'll pay very little when you visit a provider. If more predictable monthly costs are important for you, the Medigap add-on could be a good choice.

4. Medicare Advantage coverage

Medicare Advantage (Part C) is sold by private insurance companies. These plans provide many of the same benefits as Original Medicare, plus additional coverage. Monthly premiums are typically low, and Medicare Advantage also caps your out-of-pocket spending. Depending on the plan, Medicare Advantage may include:

• Dental
• Fitness
• Hearing
• Prescriptions
• Travel coverage
• Vision

Most Medicare Advantage plans use provider networks, so you may need to check if your doctors are covered. These plans work with trusted doctors and hospitals to offer you high-quality services at a lower cost. Going to in-network providers is usually less expensive. Some companies, such as Highmark, may also cover costs for you to visit providers outside of your plan's network.

There are some distinct benefits of enrolling in a Medicare Advantage plan. It provides additional hospital care and health benefits such as dental care and prescription coverage as part of the plan. And it also limits your out-of-pocket expenses, which Original Medicare doesn't.

5. D-SNP coverage

Those who qualify for both Medicare and Medicaid are "dual eligible." If you meet this requirement, you are eligible for a Dual Eligible Special Needs Plan (D-SNP). These plans combine Medicare and Medicaid coverage into one plan and often include prescription drug coverage along with additional support services.

D-SNP plans are designed to simplify care and help coordinate benefits across both programs, making them a good choice for those who qualify and want extra assistance managing their healthcare.

Who is eligible for a D-SNP plan?

You may be eligible for a D-SNP plan if you:

• Are a U.S. citizen or a lawful, permanent resident.
• Qualify for Original Medicare (Parts A and B).
• Qualify for your state's Medicaid program.
• Live in an area where D-SNP is offered.

Medicare combinations

While there are numerous ways to combine or add coverage, here are the five most common combinations:

Medicare Advantage plus VA benefits

If you're a veteran, you may be able to have both VA benefits and a Medicare Advantage plan at the same time. Having both plans can give you more flexibility in where you receive care and additional benefits not always included with VA coverage or TRICARE for Life — such as hearing, vision and allowances for over-the-counter healthcare items.

One thing to keep in mind is that even if you use VA benefits, enrolling in Medicare Part B is often important. It can help you avoid late penalties and gives you nationwide access to doctors and hospitals that accept Medicare. 

Highmark offers a $0 Medicare Advantage health insurance for veterans — Freedom Blue PPO Valor plan (Pennsylvania, West Virginia, and Delaware) and Freedom Valor PPO plan (Western New York) — specifically developed to work with VA benefits. It's a great choice for veterans who want to add coverage to the care they already receive through the VA. And it comes with a lot of additional benefits:

• Local and nationwide access to a broad network of providers and hospitals
• Dental insurance, vision and hearing coverage
• Low copays for PCPs, specialists and mental health services
• Local customer service

Choose the right plan

Need help choosing which plan is right for you? Answering these questions can help you decide what Medicare benefits are important to you, your need for physician and network flexibility and what types of monthly costs you are comfortable with.

1. How important is being able to see any doctor?
2. Is monthly cost predictability important to you?
3. Do you need extra benefits?
4. Do you qualify for both Medicare and Medicaid?