Original Medicare or Medicare Advantage?

Medicare Advantage

Medicare Advantage Seminar

We are right in the middle of the 2019 AEP.  The OEP begins on January 1, 2019, which will allow many folks to make another change to their Medicare benefits, if needed.

Contrary to what many people believe, though, there isn’t just one single program for receiving your Medicare benefits. In fact, while Original Medicare can certainly provide coverage for a wide range of items and services, nailing down the best plan for you can require a bit of legwork. This starts with having a good understanding of exactly what options you have available to you, and why you may – or may not – want to consider one over another.

How Medicare Works

In its most basic sense, Medicare is defined as a federal health insurance program for qualified individuals who are age 65 and over, as well as for other qualifying persons who are under age 65 and have been diagnosed with certain disabling conditions. Unlike Medicaid – which sounds similar to Medicare – the Medicare program provides coverage to qualified individuals, regardless of their income or asset level.

There are actually several components to Medicare coverage – and, depending on what you choose, you may be able to add some additional options, too. For instance, Original Medicare consists of Medicare Part A and Part B. Medicare Part A provides coverage for in-patient hospitalization, and Part B offers coverage for doctors’ services and necessary medical equipment (such as walkers, wheelchairs, canes, and other supplies that may be prescribed by your doctor).

Medicare Parts A and B can allow you the flexibility and convenience of going to any doctor or medical provider you choose (as long as they accept Medicare as payment for services). This differs from Medicare Advantage.

And, Part A and B of Medicare are not all-inclusive – in fact, there are a couple of added options that you may want to consider adding if you go the route of Original Medicare. For example, those who are enrolled in Original Medicare (Parts A and B) will not automatically have coverage for prescription medication.

So, if you want to be covered in this area, then you will need to add a Medicare Part D prescription drug plan. Unlike Medicare Parts A and B, Part D coverage is not provided directly through the Medicare program itself, but rather via private insurance carriers. And because of that, the benefits that are offered, as well as the premium price that is charged, can differ from one plan to another, and from one insurance carrier to another.

In addition, Original Medicare can also be highly fraught with out-of-pocket charges like deductibles, copayments, and co-insurance that you are responsible for paying – that is, unless you also purchase a Medicare Supplement insurance plan.

As its name implies, Medicare Supplement insurance helps to supplement Medicare’s coverage “gaps.” For this reason, Medicare Supplement is oftentimes referred to as “Medigap” insurance.

Similar to Medicare Part D (prescription drug coverage), Medicare Supplement is also offered through private insurers, as versus through Medicare itself. And likewise, the prices of the premiums can differ – sometimes significantly – from one Medicare Supplement insurance carrier to another.

The actual policy benefits, however, are identical for the various Medigap plans in the market place. Here, for instance, there are ten Medicare Supplement coverage options to choose from. These are simply named after letters of the alphabet, with Medicare Supplement Plan A providing the most basic set of core benefits, and Plan F offering the most comprehensive (at least for the time being).

As an example, Medicare Supplement Plan A includes the following benefit options:

⦁ Medicare Part A coinsurance and hospital costs – up to an additional 365 days after Medicare benefits have been used up
⦁ Medicare Part B coinsurance or copayment
⦁ The first three pints of blood each year
⦁ Medicare Part A hospice care coinsurance or copayment amount
All of the other Medicare Supplement insurance plans offer these core benefits, as well as other added coverages.

Your Route to Medicare Coverage and Choosing the Right Path

So, to summarize your route to Medicare coverage, one way could be to go with Original Medicare (Part A and Part B), with the options of adding Medicare Part D (for prescription drug coverage) and / or Medicare Supplement (to help with filling in Medicare’s coverage gaps).

As an alternative, you could instead go with a Medicare Advantage plan. These plans – which are also aptly referred to as Medicare Part C – include all of the same benefits that you would get with Medicare Parts A and B.
But these plans take it a few steps further. For instance, many Medicare Advantage plans will also automatically include Medicare Part D prescription drug coverage. So, you won’t need to add this stand-alone coverage with Medicare Advantage.

Medicare Advantage plans are not provided through Medicare itself, but rather through insurance carriers that have been approved by Medicare for doing so. Here, too, the benefits can differ – at least slightly. As an example, many Medicare Advantage plans will include additional coverage that Original Medicare does not provide, such as vision, dental, and / or wellness benefits.

However, while this may sound like the ideal way to obtain your health care coverage, before you race to your nearest Medicare Advantage sales office and make a commitment to a Medicare Advantage plan, there are some other things you need to know – which could end up saving you money, time, and frustration before it starts.

First, Medicare Advantage plans will oftentimes require that you choose your providers from a particular network. And, depending on the actual plan, if you opt to use a non-network doctor, hospital, or other provider, your services will either not be covered, or they will be more costly to you out-of-pocket.

With that in mind, if you are determined to continue using your current health care providers – and you wish to go with a Medicare Advantage plan – then be sure that your providers of choice are listed in the plan’s network before you commit to a plan.

So, where exactly should you begin when choosing which Medicare coverage option (or options) are right for you?
The following “roadmap” can help to point you in the right direction, as well as outline which steps need to be taken when.

Need More Information Regarding Which Medicare Coverage Option is Best for You?

If you need additional information about which Medicare coverage option may be right for you, it can be helpful to start by visiting the Medicare website. You can visit this site by going to: www.Medicare.gov. In addition, it can also be beneficial to discuss your health care needs and coverage alternatives with an insurance professional who specializes in Medicare plans.