Original Medicare vs. Medicare Advantage for DME: Look Beyond the Promotional Perks

Evergreen Park, IL | Updated October 2026

Advertisements for Medicare Advantage often highlight low premiums, dental benefits, grocery allowances, and fitness memberships. These benefits may be valuable, but they shouldn’t overshadow the coverage you depend on when you become ill. Medicare’s Annual Enrollment Period runs October 15 to December 7, which is exactly when those ads multiply.

For Chicagoland patients who need CPAP therapy, oxygen, walkers, wheelchairs, or other durable medical equipment (DME), Hayat Home Medical Equipment encourages a closer look at traditional Medicare, officially called Original Medicare, before changing plans.

A fair note from an equipment supplier: Medicare Advantage is a good fit for many people, with lower premiums, a yearly spending limit, and extra benefits. We won’t tell you which plan to choose, but we will tell you exactly how a plan would treat your equipment: whether Hayat is in its network, what needs prior authorization, what paperwork your doctor must complete, and what you would likely pay. That’s the part of insurance we work with every day. For free, unbiased help comparing plans in Illinois, call the state’s SHIP counselors at 1-800-252-8966.

Key Takeaways

• Medicare Advantage plans must cover everything Original Medicare covers, but supplier networks, prior authorization, and costs can differ.
• Original Medicare lets you use any Medicare-enrolled supplier. Medicare Advantage typically requires a supplier in the plan’s network.
• Neither option is automatically cheaper. Original Medicare has no yearly out-of-pocket limit without extra coverage, and Medicare Advantage has a yearly cap.
• Plan networks can change. Review your plan’s Annual Notice of Change before enrollment ends.
• If you return to Original Medicare, Medigap approval isn’t always guaranteed, though Illinois adds some protections.
• Before you switch, Hayat can check how a plan would treat your equipment, including network participation, prior authorization, documentation, and expected costs.

Is Original Medicare or Medicare Advantage Better for Equipment Like CPAP and Oxygen?

Neither is better for everyone. The right choice depends on your equipment supplier, your doctors, your budget, and how much you travel. What deserves as much attention as the advertised extras is whether your supplier will be covered under the plan. The Illinois Department on Aging’s counseling program (SHIP) specifically cautions people not to base their health care decisions solely on a plan’s extra benefits [1].

	Original Medicare	Medicare Advantage
Choosing a DME supplier	Any Medicare-enrolled supplier	Typically a supplier in the plan’s network
Prior authorization	Not needed in most cases, but required for certain items on a CMS list	May be required before the plan covers certain services or supplies
Equipment covered	Medically necessary DME under Part B	Must cover everything Original Medicare covers
Typical DME cost	20% of the Medicare-approved amount after the Part B deductible	Varies by plan
Yearly out-of-pocket limit	None, unless you add Medigap or other coverage	Yes, set by the plan
Extra benefits	Generally none, such as dental or vision	Many plans add vision, hearing, dental, and more
Medigap	You can buy it	You can’t buy it while enrolled

Sources: [2], [3], [4].

Why Can Original Medicare Offer Greater Flexibility?

Original Medicare generally lets you choose Medicare-enrolled equipment suppliers that are willing to accept you as a patient, while Medicare Advantage plans may require you to use suppliers within their network [2][3]. Ask any supplier whether they accept assignment, meaning they agree to Medicare’s approved amount as full payment. If they don’t, you can be charged more than the approved amount [1].

That difference matters when you already have a trusted DME provider who understands your equipment and ongoing needs. Before switching, confirm that your supplier participates in the specific plan, not simply the insurance company offering it. Networks can also change, and providers can join or leave a plan’s network at any time [1].

Does Medicare Advantage Cover the Same Equipment as Original Medicare?

Yes. Plans must cover all medically necessary services that Original Medicare covers [2]. The differences are in how you get that coverage: supplier networks, authorization procedures, and patient costs [3].

Original Medicare doesn’t require approval (prior authorization) in most cases, although CMS requires it for certain equipment on a published list, such as certain power wheelchairs and scooters [4]. Medicare Advantage may require plan approval before covering certain equipment or supplies [2]. Depending on the plan and circumstances, those extra steps can create delays or require an appeal.

For someone who relies on oxygen or ongoing PAP therapy, these details deserve as much attention as the advertised extras.

Do Promotional Benefits Match Your Real Needs?

An allowance you don’t qualify for, a fitness membership you never use, or a dental benefit with tight limits may provide less value than you expected. Review eligibility, participating providers, spending limits, and exclusions in the plan documents.

Ask what you could give up, not just what you could receive:

• Will you keep your DME supplier?
• What will equipment rentals and replacement supplies cost?
• Are your doctors and hospitals in the plan’s network?
• How will your ongoing treatment continue after the switch?

A plan can look attractive in an advertisement and still be a poor fit for your healthcare needs.

Is Original Medicare Always Cheaper? How to Compare the Full Cost

No. Neither option is automatically the least expensive choice. Without supplemental coverage, Original Medicare has no yearly out-of-pocket limit. For Part B equipment, you generally pay 20% of the Medicare-approved amount after the Part B deductible, which is $283 in 2026 [1].

Medicare Advantage has a yearly limit on covered Part A and Part B spending, no higher than $9,250 for in-network services in 2026 (some plans set lower limits) [5], and it may offer useful additional benefits. Original Medicare paired with a suitable Medigap policy and a separate Part D drug plan may offer greater flexibility and help with covered medical costs, but those policies carry additional premiums. Compare the complete package, not just the monthly premium.

Can I Get a Medigap Policy If I Switch Back to Original Medicare?

Not always without health screening. Medigap can’t be sold to people enrolled in Medicare Advantage, and the best time to buy it is during your Medigap Open Enrollment Period, which starts when you sign up for Part B [6]. Outside that window, or without a guaranteed issue right, insurers may use medical underwriting, so approval and pricing can depend on your health [6].

Some situations protect you. For example, if you joined Medicare Advantage when you were first eligible at 65 or older and switch to Original Medicare within the first year, you may have a trial right. Other guaranteed issue rights apply if your plan leaves Medicare or your area. In most of these cases, you must apply no more than 63 days after your Medicare Advantage coverage ends [1]. If you already have a Medigap policy and leave it for Medicare Advantage, you could face underwriting if you try to come back, unless a trial right applies [1].

Illinois adds protections beyond federal rules, according to the Illinois Department on Aging [1]:

• Birthday window: if you’re 65 to 75 and already have a Medigap policy, you have 45 days after your birthday each year to switch to a plan with equal or lesser benefits from the same company or an authorized affiliate, without health questions.
• Year-round guaranteed issue: for 2026, the state lists Blue Cross Blue Shield of Illinois as the insurer offering certain Medigap plans year-round to people 65 and older regardless of health. Confirm current availability with SHIP, since offerings change.

Confirm your rights before leaving existing coverage.

How Can Hayat Help With Insurance and Medicare Coverage for My Equipment?

Hayat helps patients understand and use their insurance coverage for the equipment they depend on, from verifying benefits to coordinating with your doctor. We don’t recommend specific plans, but we can show you what each option would mean for your equipment. Here’s what that looks like:

• Verify your benefits for the equipment and supplies you use.
• Check our participation in a plan you’re considering, before you switch.
• Guide you through prior authorization and documentation requirements for your specific items.
• Coordinate with your physician or care team on prescriptions and supporting documentation.
• Explain your expected costs, including your share after the Part B deductible.
• Keep your service consistent, with delivery and setup support for your equipment.

Bring your Medicare or plan card, a list of your current equipment and supplies, and any prescriptions or orders you have. Call (708) 422-2300 or contact our team for a coverage check before you change plans, so you know how the change would affect your equipment before enrollment ends.

What Should I Do Before I Switch Medicare Plans?

Use this checklist before the enrollment period ends:

1. Call your equipment supplier and the plan. Confirm the supplier participates in the specific plan you’re considering.
2. Read your Annual Notice of Change. Plans can change costs, coverage, and networks every year, and this notice shows what’s changing [1].
3. Ask about prior authorization for your specific equipment, such as oxygen, CPAP supplies, or mobility equipment.
4. Ask what rentals and replacement supplies will cost.
5. Check your doctors and hospitals against the plan’s network.
6. Check your Medigap rights before leaving existing coverage.

Before changing Medicare plans, contact Hayat to check our participation in the proposed plan and discuss how the change may affect your equipment services. At Hayat Home Medical Equipment, we encourage patients in Evergreen Park, Chicago, and surrounding communities to prioritize reliable access to the equipment and support they actually use.

Hayat Home Medical Equipment 3518 W. 95th Street, Evergreen Park, IL 60805 (708) 422-2300 | Contact our team

For an independent comparison, call Illinois SHIP at 1-800-252-8966 or Medicare at 1-800-MEDICARE, use Medicare’s Plan Finder, or search Medicare’s medical equipment supplier directory.

Choose coverage around your healthcare needs, not the advertisement.

Frequently Asked Questions

This article is for general educational purposes only and is not insurance, legal, or medical advice. Coverage, costs, and plan rules vary and change each year, and 2026 figures shown here may change. Hayat Home Medical Equipment does not recommend or endorse any specific plan or insurer. Always confirm details with Medicare, your plan, or a SHIP counselor before making changes.

Sources

1. Illinois Department on Aging: 2026 Medicare Choices (Senior Health Insurance Program)
2. Medicare.gov: Compare Original Medicare & Medicare Advantage
3. Medicare.gov: Medicare Coverage of Durable Medical Equipment & Other Devices
4. CMS: Prior Authorization for Certain DMEPOS Items
5. National Council on Aging: Weighing the Pros and Cons of Medicare Advantage
6. Medicare.gov: When Can I Buy a Medigap Policy?