What is the Big Difference Between Medicare and Medicare Advantage

travislanefinancia

Dec 5, 20243 min read

Big Difference Between Medicare and Medicare Advantage

Understanding Original Medicare and Medicare Advantage

Medicare can be a complex subject, especially when you're trying to understand the difference between Original Medicare and Medicare Advantage. Here at Virginia Insurance Advisors, we want to make it as simple as possible for you. Original Medicare is a federal program that includes Medicare Parts A and B, covering hospital and medical care. In contrast, Medicare Advantage, also known as Medicare Part C, is offered by private insurance companies and includes the benefits of Original Medicare but often with added perks.

Exploring the Medicare Advantage Plan

Medicare Advantage Plans cover all the services that Original Medicare covers plus some extra benefits that Original Medicare doesn’t offer, such as dental, vision, and hearing. These plans often include a Medicare part D prescription drug plan, which provides drug coverage. You might also gain access to wellness programs and other bonuses. However, Medicare Advantage Plans may have a monthly premium in addition to the Medicare Part B premium. It's important to consider your healthcare needs when reviewing these plans.

The Difference Between Original Medicare and Medicare Advantage

The biggest difference between Original Medicare and Medicare Advantage lies in the way they provide coverage. Original Medicare covers services on a fee-for-service basis, allowing you to see any doctor that accepts Medicare. On the other hand, Medicare Advantage Plans often require you to use a network of doctors and may not cover out-of-network services unless it's an emergency. Medicare Advantage Plans include everything that Original Medicare covers and often more, but they might come with network restrictions.

Does Your Doctor Accept Medicare?

When choosing between Original Medicare and a Medicare Advantage Plan, it's crucial to check if your preferred healthcare providers accept Medicare or are in the network of the Medicare Advantage Plan you're considering. Having your doctors accept Medicare ensures you can continue receiving care without interruption.

What is Medigap?

A Medigap policy, or Medicare Supplement plan, is additional insurance that you can buy to cover some of the out-of-pocket costs not covered by Original Medicare, such as coinsurance, copayments, and deductibles. These plans do not work with Medicare Advantage Plans, so it's a choice you'll need to make when deciding between Original Medicare and Medicare Advantage.

Switching: Original Medicare to Medicare Advantage

If you're considering switching from Original Medicare to a Medicare Advantage Plan, or vice versa, it's essential to weigh the benefits and limitations. While Medicare Advantage Plans offer extra benefits that Original Medicare does not, switching might mean changing your healthcare providers if they're not in the Medicare Advantage network. Consider your healthcare needs and financial situation before making a decision.

Medicare Plan Options

Both Original Medicare and Medicare Advantage Plans have different structures and benefits. Plans include various options like separate Medicare Part D plans for prescription drug coverage, or combined benefits within a Medicare Advantage Plan. It's important to compare original Medicare and Medicare Advantage to make an informed decision.

Things to Consider When Choosing Between Original Medicare and Medicare Advantage

Monthly Premiums: Consider the cost of Medicare Part B and any additional premiums for a Medicare Advantage Plan.
Coverage Network: Do you prefer the flexibility of any doctor that accepts Medicare, or are you okay with network limitations?
Extra Benefits: Are additional services like dental, vision, and wellness programs important to you?
Out-of-Pocket Costs: Evaluate potential coinsurance, copayments, and deductibles.
Prescription Drug Coverage: Consider whether you need a part D prescription drug plan.

Deciding Between Original Medicare or a Medicare Advantage Plan

Deciding between Original Medicare and Medicare Advantage should be based on your personal health needs and financial situation. Consider if a Medicare Advantage Plan may offer more comprehensive coverage or if staying with Original Medicare and a separate Medigap policy is more beneficial for you. Remember, your spouse paid Medicare taxes to ensure you have these options, so choose wisely.