Understanding Medicare Part B vs. Medicare Advantage
When it comes to Medicare, the details can be confusing. Many patients ask us about the difference between Medicare Part B or original/straight Medicare and a Medicare Advantage Plan. Here’s a straightforward guide to help you understand your coverage.
What Is Medicare Part B?
-
Traditional Medicare: Part B is part of “Original Medicare,” provided directly by the federal government.
-
What It Covers: Doctor visits, outpatient care, lab tests, preventive services, and some medications (like injections you receive in the office).
-
Freedom of Choice: You can see any doctor or specialist who accepts Medicare, without needing a referral or network restrictions.
-
Costs: You typically pay a monthly premium, an annual deductible, and a 20% coinsurance after Medicare pays its share.
Sample Image of a Medicare card
Source: Centers for Medicare & Medicaid Services (CMS), Sample Medicare ID card – used for educational purposes.
Sure that you have Medicare Part B
What Is a Medicare Advantage Plan?
-
Private Insurance Option: Also called “Part C,” these plans are offered by private insurance companies approved by Medicare.
-
Bundled Coverage: Most Advantage plans include Part B services, Part A (hospital), and often extras like prescription drug coverage, dental, or vision.
-
Networks and Restrictions: Care is usually limited to in-network doctors and hospitals. You may need referrals to see specialists.
-
Costs: Advantage plans often have lower monthly premiums, but out-of-pocket costs vary and can add up depending on the services you need.
Sample Image of a Medicare Advantage Card
Source: Centers for Medicare & Medicaid Services (CMS). Draft Model MAPD Combination Member ID Card– used for educational purposes.
Unsure if your visit will be covered
Key Differences at a Glance
Which One Is Right for Me?
-
If you value freedom to see any specialist without worrying about networks, Original Medicare Part B may be a better fit.
-
If you want a plan that bundles services and extras (like vision or drug coverage), and you’re comfortable with networks, a Medicare Advantage plan could work.
How This Affects Your Care at Kidney MD
At Kidney MD LLC, we accept Medicare Part B and bill according to CMS Guidelines. If you have a Medicare Advantage plan, we provide clear out-of-pocket pricing for visits. Many patients with Advantage plans still choose to see us directly for faster access and longer, unrushed visits.
​
👉 Still unsure about your coverage? Call our office, and we can walk you through how your Medicare plan works with Kidney MD.