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What is the difference between Original Medicare and Medicare Advantage?

You can either get your Medicare health insurance benefits from Original Medicare or Medicare Advantage (Part C). While both plans offer the same basic level of medical and hospital insurance, there are also significant differences between the two. Part C replaces the coverage of Original Medicare. Individuals who enroll in a Medicare Advantage plan will no longer receive their benefits directly from the federal government, but from a private insurance company instead. Medicare Advantage must contain at least as much coverage as Parts A and B offered, but most of them offer additional coverage.

Here are the key differences between Original Medicare (Medicare Part A and Part B) and Medicare Advantage (Medicare Part C) plans.

Coverage

Original Medicare covers inpatient (Medicare Part A) and outpatient services (Medicare Part B). Under Medicare Advantage, you will get all of the medical services covered by Original Medicare. In addition, some Medicare Advantage plans provide additional coverage not offered by Original Medicare.

Some of the additional coverage includes hearing, vision, and dental care. Some Medicare Part C plans also provide coverage for gym memberships, prescription drugs, transportation to doctor appointments, and more.

Costs

The federal government sets the premiums, coinsurance, and deductibles for Part A and Part B. For instance, under Part B, Medicare beneficiaries are responsible for 20% of a lab test or doctor visit. Medicare also sets maximum deductible rates for the Medicare Part D prescription drug program. However, copayments and premiums vary by plan.

Many people who choose Original Medicare also get a Medicare Supplement policy to help cover out of pocket costs, which could run in thousands of dollars. With the Medicare Advantage plan, you must still pay the Medicare-set annual Part B premium. But instead of paying 20% coinsurance for visiting the doctor, most Medicare Advantage plans set a copayment amount for doctor’s visit, which means you will pay lower out-of-pocket costs than Original Medicare.

Providers

Another major difference between both plans is the healthcare providers you are allowed to see. Original Medicare plans allow you to see any hospital or physician that accepts Medicare. In contrast, most Medicare Advantage plans have a you can see. If you seek medical care outside the Medicare Advantage plan’s network, you will likely pay more. However, urgent care and emergency services are covered.

Logistics

With Original Medicare, you will likely have to register for four separate elements to get the full array of services – Part A, Part B, Part D, and a Medicare Supplement plan. With that, hospitals and doctors have to file claims for each service you will need to review.

Medicare Part C combines both Medicare Part A and Part B into one plan. Moreover, about 90% of Medicare Advantage plans cover prescription drugs. You also cannot have a Medicare Supplement plan with Medicare Advantage.



If you would like to learn more about Original Medicare and Medicare Advantage and how they might benefit you, reach out to Turning 65 Solutions today.

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