When enrolling in Medicare, one of the biggest decisions is whether to stick with Original Medicare or sign up for a Medicare Advantage Plan. While both provide comprehensive medical and hospital coverage, there are some key differences between these options. Understanding how they compare will help you choose the right plan.
Understanding Original Medicare and Medicare Advantage
Original Medicare consists of Part A and Part B. It is the federal government’s traditional fee-for-service health insurance program. Medicare Advantage, sometimes called Part C, refers to private Medicare Plans from insurance companies. They contract with Medicare to provide all your Part A and Part B benefits.
What is Original Medicare?
Original Medicare includes:
- Part A: Hospital coverage for inpatient stays, skilled nursing, hospice, home health
- Part B: Outpatient medical care like doctor visits, preventive services, durable medical equipment
You can go to any doctor or facility in the U.S. that accepts Medicare with low out-of-pocket costs.
What is Medicare Advantage Plan?
Medicare Advantage Plans combine Part A, Part B, and usually Part D prescription drugs into one plan from a private insurer. Some key features include:
- Monthly premiums are often $0
- Networks of approved providers limit your healthcare choices
- Maximum annual out-of-pocket spending caps your costs
- Many offer extra benefits like dental and vision
What are the differences between Original Medicare and Medicare Advantage?
The biggest differences are provider choice flexibility versus lower costs and extra benefits. Original Medicare offers more freedom to choose any doctor while Medicare Advantage Plans have restricted networks but cost less in premiums.
How do I choose between Original Medicare and Medicare Advantage?
When selecting between them, consider factors like:
- Your current healthcare providers – Are they in the Medicare Advantage Plan’s network?
- Needs – Do you require any extra benefits like dental or hearing aids?
- Costs – Compare premiums, deductibles, copays
- Travel habits – Original Medicare gives more flexibility
- Prescriptions – Check formulary to ensure coverage
What factors should I consider when choosing between Original Medicare and Medicare Advantage?
Key points to weigh include your budget, health status, medications, doctor preferences, travel habits, and appetite for extra benefits versus network flexibility. Enrolling when first eligible for Medicare allows you to switch between options each year to meet changing needs.
Diving into Medicare Coverage Options
Original Medicare and Medicare Advantage have some key coverage differences:
What does Original Medicare cover?
Original Medicare covers most medically necessary care at 80% after you meet the deductible. You pay 20% coinsurance. It does not cover vision, dental, hearing, or long-term care.
What are the coverage options under a Medicare Advantage Plan?
Plans cover all Original Medicare services, often with lower costs like copays and networks. Many also include some extra benefits like limited dental or vision coverage. Each plan varies in what’s included.
Do Medicare Advantage Plans cover prescription drugs?
Most Medicare Advantage Plans include Part D prescription drug coverage. Some integrate Medicare Part D benefits whereas others make it optional to add on Part D. You can also get drug coverage under Original Medicare through a separate Part D Plan.
What additional benefits do Medicare Advantage Plans offer?
Some common extra benefits include:
- Vision – Annual eye exams and eyeglasses allowance
- Dental – Cleanings, oral exams, discounts on large procedures
- Hearing – Annual exams, discounted hearing aids
- Fitness – Gym membership through programs like Silver Sneakers
- Transportation – To and from medical appointments
Can I purchase additional coverage like dental and vision with Medicare Advantage Plans?
Yes, you can add supplemental “Medigap” style benefits to some Medicare Advantage Plans for extra premiums to expand your coverage. These may include more comprehensive dental, vision, and other services.
Comparing Costs and Enrollment
Medicare Advantage and Original Medicare have different costs and enrollment rules:
How do the premiums compare between Original Medicare and Medicare Advantage?
- Original Medicare – Part B premium of $164.90/month for most people in 2023
- Medicare Advantage – Often $0/month but can be up to $100/month
What are the out-of-pocket costs associated with Original Medicare?
With Original Medicare, you pay 20% coinsurance for most services after meeting the $226 Part B deductible. You may want supplemental coverage like Medigap.
Can I switch from Original Medicare to a Medicare Advantage Plan?
Yes, you can enroll in a Medicare Advantage Plan during the annual open enrollment period from October 15–December 7 each year for January 1st effective dates. You can switch back to Original Medicare on this schedule as well.
What are the enrollment periods for Medicare Advantage Plans?
The Medicare Advantage open enrollment period runs from October 15 to December 7 each year. You can join, switch or drop a Medicare Advantage Plan for the following year during this window.
Is there a monthly premium for Medicare Part B coverage under Original Medicare?
Yes, you must pay the standard monthly premium of $164.90 for Part B coverage in 2023. Higher income individuals pay more based on their tax returns. The premium is deducted from your Social Security check or directly billed.
Examining Prescription Drug Coverage
Original Medicare does not cover prescriptions. Here are your options:
What type of prescription drug coverage is available under Original Medicare?
Original Medicare does not cover prescription medications. To get drug coverage, you must enroll in a separate private Medicare Part D prescription drug plan.
What is Medicare Part D prescription drug coverage?
Medicare Part D is an optional program that provides prescription drug coverage through private insurers. Plans have monthly premiums, formularies, and cost sharing like copays and coinsurance for medications.
How does drug coverage work in Medicare Advantage Plans?
Most Medicare Advantage Plans integrate prescription drug coverage (Part D) as part of the plan’s benefits. Others allow you to add on a separate Part D Plan. Review each plan’s formulary and costs.
Do I need to enroll in a separate Part D Plan if I choose a Medicare Advantage Plan?
If your Medicare Advantage Plan does not include Part D drug benefits, you will need to enroll in a standalone Part D Plan separately for drug coverage. Check your plan details.
What are the costs associated with prescription drug coverage under Medicare Advantage Plans?
With integrated Medicare Part D benefits, you’ll typically pay tiered copays or coinsurance for covered prescription medications up to an annual cap. Costs vary by plan.
Weighing Additional Factors in Decision Making
Besides costs and coverage, other considerations include:
What are the benefits of enrolling in a Medicare Supplement insurance plan alongside Original Medicare?
Adding a Medigap Plan can help pay for Original Medicare costs like the 20% coinsurance. It gives you broad provider access nationwide which is useful if you travel frequently.
What are the extra benefits provided by Medicare Advantage Plans?
Some common extra benefits include dental, vision, hearing coverage, health club memberships, transportation to medical appointments, over-the-counter allowances, and more. Benefits are not standardized across plans.
How do traditional Medicare Plans differ from Medicare Advantage Plans concerning coverage and costs?
Original Medicare covers services nationally but you pay 20% coinsurance after deductibles. Medicare Advantage Plans have local provider networks, copays instead of coinsurance, annual out-of-pocket limits, and sometimes extra benefits.
What are the factors to consider when choosing between traditional Medicare and Medicare Advantage Plans during the open enrollment period?
Look at your budget, health needs, medications, doctors, use of healthcare services, travel habits and appetite for extra benefits like dental or vision coverage. Compare total estimated costs.
What types of plans also accept Medicare?
Most Medicare Supplement (Medigap) plans work alongside Original Medicare coverage. Some retiree employer plans also coordinate coverage with Medicare benefits in certain ways.
Deciding between Original Medicare or a Medicare Advantage Plan can be challenging. Evaluating your priorities, health, prescriptions and budget will help ensure you select the optimal coverage to meet your needs.
We’re Here to Help
You do not have to spend hours reading articles on the internet to get answers to your Medicare questions. Give the licensed insurance agents at Think65 a Call at (719) 301-1220. You will get the answers you seek in a matter of minutes, with no pressure and no sales pitch. We are truly here to help.
FAQs
What is the difference between Original Medicare and Medicare Advantage?
Original Medicare is a fee-for-service health plan offered by the federal government, while Medicare Advantage is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits.
How do I transition from Original Medicare to Medicare Advantage?
To switch from Original Medicare to Medicare Advantage, you can simply enroll in a Medicare Advantage Plan during the annual Medicare Open Enrollment period.
What are the key differences between Original Medicare and a Medicare Advantage Plan?
Original Medicare consists of Medicare Part A (hospital insurance) and Part B (medical insurance), while Medicare Advantage combines both Part A and Part B coverage and often includes additional benefits such as prescription drug coverage, dental, and vision care.
Can I have Medicare and a Medicare Advantage Plan at the same time?
No, you cannot have both Medicare and a Medicare Advantage Plan simultaneously. You must choose one or the other.
Do I have to pay a premium for a Medicare Advantage Plan?
While most people do pay a premium for their Medicare Part B coverage, some Medicare Advantage Plans may offer premiums as low as $0 in addition to the Part B premium.
Does Original Medicare cover dental care?
Original Medicare typically does not cover routine dental care. However, some Medicare Advantage Plans may offer dental coverage as an added benefit.
What are the advantages of enrolling in Original Medicare compared to a Medicare Advantage Plan?
Original Medicare allows you to see any doctor or provider that accepts Medicare, while Medicare Advantage Plans often have network restrictions. Additionally, Original Medicare doesn’t require prior authorization for services.
What is the Medicare Open Enrollment period?
The Medicare Open Enrollment period is a time during which Medicare beneficiaries can make changes to their health and prescription drug coverage for the following year.
Does Original Medicare cover everything?
Original Medicare doesn’t cover everything, and beneficiaries may choose to buy a Medicare Supplement Plan to help pay for costs not covered by Parts A and B.
Are there any specific services offered by Original Medicare that are not included in Medicare Advantage Plans?
Original Medicare offers some services and coverage that may not be included in Medicare Advantage Plans, such as hospice care and certain types of skilled nursing facility care.