Original Medicare vs. Medicare Part C: Why Everyone Still Needs an Annual Plan Checkup

When you enroll in Medicare, one of the biggest choices you make is how you receive your benefits: through Original Medicare or Medicare Part C (often called Medicare Advantage). With Original Medicare, your hospital and medical coverage are managed directly by the federal government, giving you the freedom to visit nearly any doctor or hospital in the country that accepts Medicare. Many of these beneficiaries pair this with a separate, standalone Part D (prescription) plan. On the other hand, Medicare Part C beneficiaries receive their benefits through a private, Medicare-approved insurance company. These plans typically bundle hospital, medical and prescription drug coverage, along with extra perks like dental or vision benefits. Many times you need to use doctors and hospitals within the plan’s local network.

Because Medicare Part C plans are run by private insurers with networks and benefits that change noticeably each year, Part C beneficiaries shop around every fall during Medicare Open Enrollment (October 15 through December 7). However, if you have Original Medicare, it is easy to assume you can tune out the Open Enrollment reminders because your coverage stays largely the same from year to year. What many people overlook is that while Original Medicare doesn't change much, your standalone Part D prescription drug plan does. Every January 1, Part D plans can adjust their monthly premiums, annual deductibles, preferred pharmacy networks, and—most importantly—their formulary (the list of medications they cover and the copay tier for each drug).

As a pharmacist, I always recommend that everyone—including Original Medicare beneficiaries—take 15 minutes during Open Enrollment to compare their coverage options for the upcoming year. Even if you love your doctors and haven't started a single new medication, doing a quick annual comparison on Medicare.gov ensures your Part D plan will still cover your prescriptions at the lowest possible cost in the new year, and gives you a chance to see whether your overall setup still fits your health and budget. Before the December 7 deadline arrives, gather your current medication list, check your plan's Annual Notice of Change letter, and compare your options—because a quick fall checkup is the easiest way to avoid an expensive surprise at the pharmacy counter in January!