Get More Benefits in One Comprehensive Plan
If you’re enrolled in Original Medicare, you have an important decision to make. You can stick with Original Medicare or opt to enroll in a Medicare Advantage plan. As more and more seniors across the U.S. switch to Medicare Advantage, we want to ensure that you fully understand the difference between Medicare Advantage and Original Medicare so you can make the choice that best meets your individual needs.
Original Medicare
First, let’s briefly look at the Original Medicare plan. This plan is provided by the government and works as follows:
- Medicare Part A covers hospital stays.
- Medicare Part B covers doctors’ visits.
Unfortunately, if you are like most seniors, Medicare won’t cover all your health care services and supplies. Most people also need prescription drug coverage, which is covered by Medicare Part D and not included in Original Medicare. You will have to pay for this additional coverage separately if you want it.
Even if you have Medicare Parts A, B and D, you may still incur additional medical expenses that you must pay out of pocket, such as dental, hearing and vision services.
To cover these expenses, people often purchase additional insurance called Medicare Supplement Plans or Medigap Policies offered by private insurance companies. These policies cover the “gaps” in your Original Medicare coverage, such as copays, coinsurance and deductibles. There are a range of Medicare Supplement plans available to meet your specific needs, but again, these plans are separate from Original Medicare, and you must pay for them separately.
Ultimately, Original Medicare alone is not typically enough coverage for most seniors – so you will also have to purchase prescription coverage and a Medicare Supplement plan. That means that you will have to manage three or more policies. This can be cumbersome, costly and stressful – especially if you have a number of healthcare expenses.
Medicare Advantage
Fortunately, there is another simpler option for Medicare-eligible people – Medicare Advantage. Medicare Advantage plans, or Medicare Part C, are plans offered by private insurance companies who have been approved by Medicare.
Medicare Advantage plans combine all the benefits of Original Medicare Parts A and B, and often include prescription drug coverage. Additionally, some plans include dental and vision coverage, and other extra benefits, all for a single monthly plan premium.
It’s important to note that switching to a Medicare Advantage plan does not mean that you are giving up your original, government-funded Medicare benefits. Medicare pays the private insurance companies who offer Medicare Advantage to cover your Original Medicare benefits.
It’s also important to understand that Medicare Advantage is not the same as the Medicare Supplement or MediGap plans we discussed earlier. It is one, single comprehensive plan that includes Original Medicare (Parts A & B), and often includes prescription drug coverage and additional benefits. With Medicare Advantage, you pay one monthly premium.
Frequently Asked Questions about Medicare Advantage
What types of Medicare Advantage Plans are available?
Medicare Advantage plans come in a variety of plan types including Health Maintenance Organization (HMO) plans, Preferred Provider Organization (PPO) plans, Private Fee-for-Service (PFFS) plans, Special Needs Plans (SNPs), HMO Point-of-Service (HMOPOS) plans and Medical Savings Account (MSA) plans.
Explore your Medicare Advantage plan options to determine the specific plan type that best meets your needs.
Who can join a Medicare Advantage Plan?
You must have Medicare Parts A and B and live in the plan’s service area and meet all Medicare Advantage plan requirements to be eligible to join. For example, those with End-Stage Renal Disease (permanent kidney failure) generally can’t join a Medicare Advantage plan.
How much do Medicare Advantage Plans cost?
Each Medicare Advantage plan has different premiums and costs for services, so it’s important to compare plans in your area and understand plan costs and benefits before you join.
What do Medicare Advantage Plans cover?
Medicare Advantage plans covers all the services Original Medicare covers except hospice care. Original Medicare covers hospice care even if you’re in a Medicare Advantage plan.
Medicare Advantage plans must also always cover emergency and urgent care. Medicare Advantage plans are required to include emergency coverage outside the plan’s service area (but not outside the U.S.).
Many Medicare Advantage plans also offer extra benefits such as dental care, vision care or wellness programs. Most Medicare Advantage plans include Medicare prescription drug coverage (Part D).
How to Enroll
You must first enroll in Medicare Part A and Part B before joining a Medicare Advantage plan.
Traditionally, the usual age of eligibility for Medicare is 65. However, this “age-in” period actually begins three months prior to your 65th birthday and continues for an additional three months after the celebration, affording you time to thoroughly research your options and make the right selection for you.
There is then a Medicare Open Enrollment Period, October 15 – December 7, during which you can make changes to your policy, which include:
- Join a Medicare Advantage (Part C) plan.
- Discontinue your Medicare Advantage plan and return to Original Medicare (Part A and Part B).
- Change from one Medicare Advantage plan to another.
- Add or change your Prescription Drug Coverage (Part D) plan if you are in Original Medicare.
Also, as of 2019, a new Medicare Advantage Open Enrollment Period will run from January 1 – March 31 every year. If you are enrolled in a Medicare Advantage plan, you will have a one-time opportunity to make changes to your Medicare coverage, which includes switching to a different Medicare Advantage plan OR returning to Original Medicare with the option to sign up for a Prescription Drug Coverage plan.
Talk to a Medicare Advantage Plan Insurance Provider for guidance in selecting the right healthcare plan for you and to help guide you through the enrollment process.
