Choosing the right healthcare coverage plan can be a daunting task, especially regarding Medicare. Individuals who turn 65 or who have certain disabilities may qualify for Medicare, which is a federal health insurance program. However, selecting between Medicare and Medicare Advantage (also known as Medicare Part C) can be difficult.
Here’s what you need to know about the difference between Medicare and Medicare Advantage:
Original Medicare (Part A and Part B)
Medicare Part A covers hospital care, skilled nursing, hospice care, and home health care. If a person has worked and paid taxes for 40 or more quarters, they may be entitled to Part A for free. Otherwise, they may have to pay a premium. Medicare Part B covers medical services such as doctor’s visits, preventive care, and medical equipment. A monthly premium is required for Part B, and individuals may have to pay a deductible and coinsurance for each service utilization.
Medicare Advantage
Medicare Advantage is an alternative to Original Medicare (Part A and Part B). By choosing a Medicare Advantage plan, individuals can receive extra benefits and coverage, including prescription drug coverage, dental, vision, or hearing coverage. Private insurance companies offer these plans, but they must provide at least the same level of coverage as Original Medicare.
One of the key differences between Original Medicare and Medicare Advantage is the flexibility of choosing a healthcare provider. In Original Medicare, individuals can choose any healthcare provider in the U.S. who accepts Medicare. On the other hand, Medicare Advantage plans often have preferred provider networks, which means one will receive the most benefits when using providers in the network. In some cases, Medicare Advantage providers may also have restrictions and require referrals to see specialists.
Cost is another significant consideration when comparing the two programs. With Original Medicare, individuals have a higher out-of-pocket responsibility. One will need to pay the Part B premium, and can pay for additional coverage like a private Medicare Supplement plan or additional prescription drug coverage.
Medicare Advantage plans consolidate the benefits of Original Medicare and often offer additional benefits, such as prescription drug coverage, dental, vision, and hearing coverage. This may mean that the monthly premium is higher for a Medicare Advantage plan, but the out-of-pocket costs are generally less. Medicare Advantage has an annual limit for out-of-pocket expenses, which means there is a cap on how much one can spend each year on medical services.
Choosing the right Medicare plan depends on your individual needs. If you are someone who is in good health and do not anticipate the need for many doctor visits or medical equipment, Original Medicare might be a good option. However, if you need more comprehensive coverage, including prescription drug coverage or additional benefits, a Medicare Advantage plan may be the better choice.
In conclusion, it is important to thoroughly understand the differences between Original Medicare and Medicare Advantage in order to make an informed decision. Consulting with a licensed insurance agent or a trusted healthcare provider can help answer any questions and ensure that a person is selecting the right plan that fits their healthcare needs and budget.
For more information on Medicare please feel free to give us a call at 223-400-7474, or check out the official Medicare website at: https://www.medicare.gov/