| Thu, Feb 23, 2012 @ 09:00 AM

Medicare Advantage Plans: Original Medicare Coverage and More

Posted by Medicare Made Clear

P A17 G26  000557 resizeWhen researching Medicare options, it’s important to know what’s available. This way, you can make sure you’ll have the coverage and benefits you need for the coming year. One important decision you have to make might be between Original Medicare and a Medicare Advantage plan.

Original Medicare – Basic Coverage for Your Health Care Needs

Medicare is a federal program that provides access to health insurance for people 65 or older and people younger than 65 with certain disabilities. Original Medicare is health insurance run by the federal government under the Medicare program.

Original Medicare is a government benefit and includes Part A and Part B. Part A helps pay for care you receive in a hospital or a skilled nursing facility. Part B helps pay for doctor visits and other outpatient medical services. Original Medicare provides the same coverage for the same cost to everyone who has it. Original Medicare doesn’t generally include prescription drug coverage. If you need this coverage, you’ll need to buy a standalone Medicare Part D prescription drug plan.

Medicare Advantage – Additional Coverage and Extra Benefits

Medicare Advantage plans (Medicare Part C) are offered by private insurance companies and offer another way to get Medicare benefits. Every Medicare Advantage plan provides the same coverage offered by Original Medicare. Beyond that, plan benefits and pricing can vary a great deal.

Here are some of the extra benefits you can get with a Medicare Advantage plan. Again, plan benefits can vary greatly from plan to plan, so keep this in mind when doing your research.

  • Prescription drug coverage

  • Dental care, eye care and hearing care coverage

  • Wellness and fitness programs

  • Worldwide urgent care and emergency coverage

  • Mail order pharmacy benefit

  • Cap on out-of-pocket costs

  Compare Costs

One important way Original Medicare differs from Medicare Advantage plans is cost. These are some of the differences you might see:  

  • Deductibles – In Medicare Part A, you’ll pay a deductible for each “benefit period.” A benefit period begins when you enter the hospital and ends when you have been out of the hospital for 60 days in a row. In 2012, this amount is $1,156. For Part B, you’ll pay a yearly deductible, which in 2012 is $140. Most Medicare Advantage plans use deductibles in combination with other cost sharing arrangements, like copays and coinsurance. You should look at an individual plan to see what this amount will be.

  • Copays and Coinsurance – In Original Medicare Part A, you’ll only pay a copay after the 60th day of a long hospital stay, when it will be a daily copay. Some cost sharing in Medicare Part B uses copays, while some uses coinsurance. For copays, Medicare sets a dollar amount that you will pay for each service or product you use. For coinsurance, Part B generally pays 80% of the cost and you pay the remaining 20%. However, there are some exceptions to this rule. Copays and coinsurance amounts vary widely between Medicare Advantage plans, so be sure to take this into consideration when finding a plan that fits your finances.

  • Premiums – Most people don’t pay a premium for Original Medicare Part A. For 2012, Part B premiums range from $99.90 to $319.70 per month. Just like all coverage costs, the premiums charged by Medicare Advantage plans are up to companies offering them and can vary widely from plan to plan. While premiums are not the only consideration when you’re looking at plan costs, it can be an important one.

  • Annual out-of-pocket expense cap – Original Medicare has no out-of pocket cap on expenses. All Medicare Advantage plans must cap your annual out-of-pocket expenses at a level set by Medicare. These expenses can include deductibles, copays and coinsurance. Premiums are not included. For 2012, this cap is $6700. 

Medicare Plan Finder – Compare Plans in Your Area

If you choose to explore Medicare Advantage plans, you will likely find many plans in your area to learn about and compare. You can get a complete list of what’s available by using the Medicare.gov plan finder.  You simply enter some basic information—like your ZIP code—and the site generates a list of plans available in your area. For each plan, you’ll get a summary of coverage, premiums, deductibles, copays, estimated annual costs and more. This lets you select the plans you’re interested in and compare them side-by-side. If you find a plan you like, you can even enroll online.

For more information contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048. You can also contact UnitedHealthcare® Medicare Made Clear to learn more at 1-877-619-5582, TTY 711, 8 a.m. – 8 p.m. local time, seven days a week.  


What is a Medicare Advantage Plan (Part C)? – Medicare.gov

Decide How to Get Your Medicare – Medicare.gov

CMS’ Medicare & You – Medicare.gov

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