The good news for seniors today is that there are more Medicare options than ever before. In addition to Original Medicare, there are many different Medicare Advantage plans to choose from. But which one is right for you: Original Medicare vs Medicare Advantage?
ORIGINAL MEDICARE
Under Original Medicare, you get your benefits directly from the federal government. Original Medicare benefits include two parts, Part A and Part B, that provide your hospital and medical insurance. Medicare Part B premiums are set each year by the federal government and most people pay the same standard rate.
Part A covers inpatient care when you are admitted to a hospital or skilled nursing home. It also covers hospice care and certain kinds of home health care. Part B pays for outpatient expenses like doctor visits, x-rays, and lab tests. It also covers durable medical equipment like wheelchairs and home oxygen supplies.
There is no coverage for prescription drugs under Original Medicare, but you can enroll in a private Part D plan.
There is one thing to keep in mind if you choose Original Medicare benefits. There is no limit to how much you pay out-of-pocket each year. For example, if you need chemotherapy, your 20% responsibility could be an awful lot.
For this reason, most people who choose Original Medicare will also buy a Medigap plan. Medigap plans pick up where Medicare leaves off; some even offer “first dollar” coverage. With a first-dollar plan, even your deductibles are paid by Medigap.
MEDICARE ADVANTAGE
Medicare Advantage is a popular alternative. What is a Medicare Advantage plan? Well, it’s very similar to group health insurance that you’ve had during your working years. These plans have networks and you pay for medical services as you go along.
Medicare Advantage is also known as Medicare Part C. It is technically still a part of Medicare, but it is not sold or managed by the federal government. The government sets rules and guidelines, but private insurance companies sell and administer the plans.
Medicare pays the insurance company to administer your Part A and B benefits through the Medicare Advantage plan. While all plans must cover the same services as Parts A and B, most offer part D (drug coverage), different Medicare Advantage plans will have different networks, copays, and drug formularies.
All Medicare Advantage plans have to offer the same benefits you’d get under Original Medicare. However, many go beyond and offer other coverage like routine vision and dental care to their members. Some even have wellness programs, gym membership discounts, and 24-hour nurse hotlines.
You may have heard of a “zero premium” Medicare Advantage plan. A zero-premium plan simply means that it doesn’t add any additional premiums above what you are already paying for Part B. (You must have both Part A and Part B to enroll in a plan).
There is one very important difference between Original Medicare vs Medicare Advantage, however. Medicare Advantage plans have a maximum out-of-pocket limit or MOOP. Once you hit your MOOP, you pay nothing for covered healthcare for the rest of that calendar year.
If you would like assistance, have questions or just want a second opinion on your current Medicare plan we would love to speak with you. Please call our office at (336) 553-7189.
