What’s the Difference Between Original Medicare and Medicare Advantage in Tennessee?

Learn the key differences between Original Medicare and Medicare Advantage in Tennessee, including doctor choice, costs, and extra benefits. Billy Jordan of The Jordan Insurance Agency breaks it down in plain language.

In this episode

• Compare doctor choice, referrals, and provider networks in Tennessee
• Understand out-of-pocket costs and yearly limits for each option
• Learn how drug coverage and extra benefits differ between plans

Source: Compare Original Medicare & Medicare Advantage (medicare.gov)

Billy Jordan is a licensed insurance agent (NPN 8699876) with The Jordan Insurance Agency, with an office in Nashville, Tennessee. Voices in this episode are AI-generated, including Billy's, from a script reviewed and approved by Billy Jordan, a licensed insurance agent. General education only, not advice for your specific situation.

Not affiliated with or endorsed by Medicare or any government agency.

Tanya (AI host): What are the main differences between Original Medicare and Medicare Advantage in Tennessee? There are a lot of details that can trip people up, so stick around if you want to know what really matters.

Tanya (AI host): Welcome to Smart Coverage. Real Advice., the insurance podcast from The Jordan Insurance Agency. I'm Tanya, your host, and I'm here with Billy Jordan, a licensed insurance agent and the president of The Jordan Insurance Agency.

Billy Jordan: Glad to be here, Tanya. A quick disclaimer: we're not affiliated with or endorsed by Medicare or any government agency, and this is general education, not advice for your situation. Now, let's get into it.

Tanya (AI host): So Billy, let’s start with the basics. What’s the biggest difference between Original Medicare and Medicare Advantage, according to medicare.gov?

Billy Jordan: The main difference comes down to how you get your coverage and your choice of doctors. With Original Medicare, you can use any doctor or hospital in the U.S. that takes Medicare. Medicare Advantage plans usually have a network, so you may need to use their doctors and hospitals for non-emergency care. Some plans allow you to go out of network, but it may cost more.

Tanya (AI host): So if someone in Tennessee likes their doctor, they need to check if that doctor’s in the plan network, right?

Billy Jordan: Exactly. With Original Medicare, you have more freedom to see providers who take Medicare, anywhere in the country. With Medicare Advantage, you want to check that your doctors and hospitals are in-network before you join.

Tanya (AI host): And what about referrals? Is it true you need one to see a specialist on Medicare Advantage?

Billy Jordan: Sometimes, yes. With Original Medicare, in most cases you don’t need a referral to see a specialist. Many Medicare Advantage plans do require a referral from your primary doctor before you can see a specialist.

Tanya (AI host): That could be a hassle if you’re used to just making your own appointments.

Billy Jordan: It definitely can be. It’s one of those things that’s easy to miss until you run into it.

Tanya (AI host): Let’s talk money. How do the costs compare between Original Medicare and Medicare Advantage?

Billy Jordan: With Original Medicare, after you pay your deductible, you usually pay twenty percent of the Medicare-approved amount for services. That’s called coinsurance. You also pay a monthly premium for Part B, and if you want drug coverage, you pay a separate premium for a drug plan. Medicare Advantage plans have different out-of-pocket costs depending on the plan. You still pay the Part B premium, and you may also pay the plan’s premium. Most Medicare Advantage plans include drug coverage, so you don't usually need a separate drug plan or premium. Out-of-pocket costs can vary based on the plan and the services you need.

Tanya (AI host): What about yearly limits? I’ve heard people talk about a “maximum out-of-pocket”—how does that work?

Billy Jordan: That’s a key difference. Original Medicare doesn’t have a yearly limit on what you pay out-of-pocket for services—unless you have extra coverage like a Medigap plan, or employer or Medicaid coverage. Medicare Advantage plans have a yearly limit on what you pay for covered Medicare services. Once you reach your plan’s limit, you pay nothing for covered services for the rest of the year.

Tanya (AI host): Can you buy Medigap with Medicare Advantage?

Billy Jordan: No, you can’t. Medigap is only for people with Original Medicare. If you have Medicare Advantage, you can’t buy a Medigap policy to cover your out-of-pocket costs.

Tanya (AI host): Let’s talk about what’s covered. Are the benefits the same?

Billy Jordan: All Medicare Advantage plans must cover all medically necessary services that Original Medicare covers. Medicare Advantage plans may also offer extra benefits that Original Medicare doesn’t, like some vision, hearing, or dental services. For the basics, both cover medically necessary care.

Tanya (AI host): What about drug coverage? Is there a difference?

Billy Jordan: Yes. With Original Medicare, if you want drug coverage, you need to join a separate Medicare drug plan, called Part D, and pay an extra premium. Most Medicare Advantage plans include drug coverage, so you don’t have to sign up separately.

Tanya (AI host): Does Original Medicare or Medicare Advantage cover care outside the U.S.?

Billy Jordan: Original Medicare generally doesn’t cover medical care outside the U.S., but you may be able to buy a Medigap policy that covers emergency care outside the U.S. Medicare Advantage plans generally don’t cover care outside the U.S., but some plans may offer an extra benefit that covers emergency and urgently needed services when traveling outside the U.S.

Tanya (AI host): Three things to remember. One, Original Medicare lets you see any doctor who takes Medicare, while Medicare Advantage usually has a network. Two, Medicare Advantage plans have yearly out-of-pocket limits, but Original Medicare doesn’t unless you add Medigap. Three, you can’t have Medigap and Medicare Advantage at the same time, and drug coverage works differently for each.

Tanya (AI host): For a personalized look at your situation, book a free thirty-minute chat with Billy and his team at thejordaninsuranceagency.com/podcast.

Billy Jordan: I'm Billy Jordan with The Jordan Insurance Agency. Until next time, take care.

Tanya (AI host): Thanks for listening to Smart Coverage. Real Advice. from The Jordan Insurance Agency.