Choosing Your Medicare Coverage: Original Medicare vs. Medicare Advantage

Navigating Medicare plan options and selecting the right coverage for your needs can be challenging. If you’re nearing the time when you’re considering your options, it is a good idea to have a basic understanding of what Medicare plans are available, and how benefits and costs can vary. From comparing benefits to weighing coverage options, here’s what you need to know about Medicare and Medicare Advantage.

What Is Covered Under an Original Medicare Plan?

The federal government provides Original Medicare as a healthcare plan for eligible recipients. Enrollees in Original Medicare receive coverage consisting of two parts: Part A (hospital coverage) and Part B (medical coverage). Part A is there to provide coverage for hospital visits, inpatient care, skilled nursing facilities, hospice care and at-home care. Part B provides coverage for outpatient care, such as doctor’s visits, surgery, lab tests, preventative exams and more. For covered services such as these, beneficiaries pay an out-of-pocket deductible as well as 20% coinsurance for Part B, on top of plan premiums. The federal government sets the premium for Part B and can change the amount annually.

Is Original Medicare the Right Plan for You?

One of the benefits of selecting an Original Medicare plan is that Medicare is accepted by nearly one million physicians, which means you are likely to find a doctor or other medical provider in your area who accepts Medicare. With Original Medicare, there is no out-of-pocket maximum on the copayments and coinsurance you incur for covered services. Expenses for covered medical care can add up quickly, along with the cost of medical care and prescriptions that fall outside of Original Medicare coverage. Taking these factors into account, it is important that you understand other available options beyond Original Medicare that may help limit your out-of-pocket costs, such as a Medicare Supplement plan.

How Does a Medicare Advantage Plan Differ from Original Medicare?

There are a few key differences between Original Medicare plans (offered by the federal government) and Medicare Advantage plans (offered through private insurance companies). With Original Medicare plans, you are generally subject to a 20% coinsurance cost on medical bills with no limit on how much you end up spending. Medicare Advantage plans will cap your medical expenses through out-of-pocket (OOP) maximums mandated by the Centers for Medicare & Medicaid Services (CMS). These maximums change each year, and for 2020 the amount is capped at $6,700 for each beneficiary. Medicare Advantage plans tend to offer additional benefits, such as coverage for care relating to vision, hearing and dental needs. For example, Medicare Advantage plans most often bundle Part A and Part B with Part D plans that offer prescription drug coverage, which isn’t part of Original Medicare. The additional benefits and coverage, as well as the caps on out-of-pocket costs, make Medicare Advantage plans a highly sensible option for many eligible recipients.

Keep in mind that Medicare Advantage plans offer coverage through a network of approved doctors, specialists, providers, hospitals and facilities. The type of Medicare Advantage plan you choose impacts your access to providers.

At Medicare Portal, we understand that each individual has different needs for their medical coverage. That’s why our local Medicare insurance agents are here to help you navigate the process of selecting a Medicare plan that meets your needs. Not sure how to start the process of choosing a plan and enrolling in Medicare? Our team is standing by to assist you – give us a call today!

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