But is this really any different from how 386 did things?
Yes, it is. 386 added a VMU. Means that the memory address you're manipulating and the actual position of the buffer on a memory chip or harddisk swapfile can freely varry.
Which, together with the larger address space offered by the 32bit architecture, offers the possibility to do "flat" memory model.
Where you allocate 4GiB worth of address and let the processes access wherever it wants.
Means that the typical DOS protected mode game saw simply the whole address range, including RAM and including the address range used by the GFX card. All at the same time.
A pointer to memory address can be thought of as consisting of two parts: a segment identifier and an offset within that segment. 386 and later simply uses lots of small, fixed-size segments called pages sized and arranged so that segment identifiers and offsets can be interpreted as contiguous numeric ranges, streamlining management and programming.
Well, except that in the 386, the VMU is an entirely different additionnal layer that sits between the segmentation (still present) and the physical RAM / devices.
You're free to use both segmenting and VMU at the same time, though most environment did decide to go for a Flat memory model and more or less ignore the segmentation.
(DJGPP's DOS Extender was an example: it still used segmentation in its GFX drivers. Either using segments to point to whichever address range the PCI card is mapping the frame buffer (for modern PCI card with a linear frame buffer). Or pointing to an arbitrary region of the address space, which is then paginated using virtual memory to the video memory bank - for older cards with a banked frame buffer accessed at a fixed physical address, one bank at a time)
Also pages have several restriction that segments doesn't have (their are fixed size, aligned, non over-lapping, can be accessed across boundaries between two pages in a single 32bit read, etc.)
And have completely different attributes associated with them.
at that point, the comparison completely breaks. It's like saying that orange are basically the same as apples, except that their skin is different, the seeds are not alike and the fruit flesh is not the same (whereas the only things they have in common is that they are fruits).