Choosing Between Original Medicare and Medicare AdvantagePosted by Medicare Made Clear
When choosing between Original Medicare (Medicare Parts A and B) and Medicare Advantage (Medicare Part C), it’s important to understand what each offers and to compare benefits as well as costs.
Original Medicare is an insurance plan provided by the federal government to people age 65 and older and to people younger than 65 who have certain disabilities. It includes two separate components: Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). Together, they form an insurance plan that helps pay for many, but not all, hospital and medical costs.
With Original Medicare, you have your choice of hospitals, doctors and other providers. You are responsible for deductibles, copays and coinsurance, whether out of your own pocket or through a Medicare Supplement Insurance plan that you can purchase from a private insurance company. Medicare Part A is premium-free for most people, but Part B comes with a premium.
Prescription drug coverage (Medicare Part D) is not included with Original Medicare. Private insurance companies offer prescription drug plans that can be purchased separately.
Private insurance companies approved by Medicare, offer Medicare Advantage (Medicare Part C) plans. These plans include all the coverage found in Original Medicare, plus additional benefits such as preventive care, dental, vision and hearing exams and wellness services. Many Medicare Advantage plans also include prescription drug benefits. Hospice care is not covered by Medicare Advantage and remains covered under Medicare Part A. You can keep your Medicare Advantage plan and receive hospice at the same time, however.
Some Medicare Advantage plans require or encourage plan members to use network physicians, hospitals and other medical services and facilities. If you see an out-of-network provider, then you will typically pay more for any services you receive. Other plans allow you to get care from any Medicare-eligible provider who accepts the terms, conditions and payment rates of the plan without charging more.
When you join a Medicare Advantage plan, you continue to pay your Part B premium (and Part A premium, if you currently pay one) to Medicare. Some Medicare Advantage plans may charge an additional premium, though some do not. Plans may also charge deductibles, copays or coinsurance, and these costs vary by plan.
Comparing Costs: Beyond Premiums
Most people look at premiums when comparing the costs of Medicare plan choices, but it’s also important to look at what you could pay in deductibles, copays and coinsurance. After meeting the Medicare Part B deductible, for example, you typically pay 20% of the Medicare-approved amount for services while Medicare pays 80%. Copays, deductibles and coinsurance may also apply for Part A services.
Each Medicare Advantage plan decides its own cost sharing terms and amounts, but all plans are required to cap your yearly out-of-pocket spending. Also, the total benefit package that a Medicare Advantage plan may provide typically includes coverage for services not covered by Original Medicare. These additional benefits can eliminate the need to buy added coverage and may balance out any cost difference that may exist between the two plan types.
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 1-877-619-5582, TTY 711, 8 a.m. – 8 p.m. local time, seven days a week.
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