Medicare Advantage Plans (MA plans) differ from Original Medicare. While Medicare is funded through the federal government, MA plans are from private insurers. Medicare is a low-cost insurance program for seniors 65 years of age or older. It also covers younger patients with disabilities or those experiencing end-stage renal disease (ESRD).
Medicare is a great way to subsidize your current care plan, especially at retirement age. Like most insurance coverages, Medicare works the same. Patients with Medicare coverage pay certain medical deductibles while the government pays off the remaining balances.
One important thing to understand about Medicare benefits is that this program is available to those who have paid Medicare taxes. Premiums and out-of-pocket costs are determined by the amount paid over a 10-year period.
Medicare Advantage Plans are a part of Medicare in some ways. Choosing the right one may seem overwhelming when examining Parts A, B, C and D of the Medicare program. Continue reading to understand which programs are the most beneficial for you.
Learn About Original Medicare Benefits
Original Medicare benefits have a determined application timeline. Those close to 65 years of age and planning to retire must apply for coverage now. This avoids future penalties for late enrollment. The required enrollment period spans seven months:
- Three months prior to turning 65 years of age
- The month in which you turn 65 years of age
- The three-month period after turning age 65 years of age
Before you wonder, “What is Medicare Part D?” you must understand Original Medicare does not include this. It only falls into two categories, Medicare Part A and Part B. Part A and Part B are the most common coverage options that seniors choose. However, each eligible person must research what is right for them and their medical needs before settling for Parts A or B.
What does Medicare Part A cover?
Medicare Part A covers most hospitalization. This includes any inpatient hospital stays, nursing facilities, hospice care or any other home care needs.
If you are unsure if this coverage allows for certain medical services, it is best to contact your healthcare provider. Your provider may prescribe a service that is typically covered but confirm with them to be sure.
What does Medicare Part B cover?
Medicare Part B coverage helps with medically necessary services and preventive care. Preventive treatment may be able to reduce the severity of an illness or attack life-threatening diseases before they become unmanageable. In general, doctor’s appointments, outpatient services, medical supplies and preventative care are included in this Medicare plan.
When considering this plan, keep in mind that not all things will qualify for Medicare benefits. Most dental care, eye exams, hearing aids and more are not considered a part of Medicare Part A or B. You may need to utilize other supplemental insurances to aid with the cost.
Learn About Medicare Advantage Plans
Medicare Advantage Plans are not the same as Original Medicare. An MA plan is traditionally offered by a private company that has a contract with Medicare. However, not all advantage plans provide all of part A or part B benefits.
Medicare Advantage Plans or Medicare Part C include the following:
- Preferred Provider Organizations (PPO): This is the most popular type of private insurance program. It is available through the health care marketplace and contains a network of doctors that you must utilize. Some PPO plans cover prescription drugs. If this is the case, then you should qualify for part of the Medicare Plan D.
- Health Maintenance Organizations (HMO): With an HMO you must find in-network providers. Some Medicare Advantage Plans allow out-of-network visits, but it may become costly. However, you may be able to go out of the network for emergency visits and urgent care or dialysis in out-of-area providers.
- Private Fee for Service Plans (PFFS): With this plan, a private insurance provider offers a Part C plan. This plan determines how much it will pay for doctors and health care provider services. This occurs only at the time of care. This plan may or may not have a network of providers for you to choose from.
- Medicare Medical Savings Account Plans (MSA): An MSA is similar to a traditional health savings account. This kind of plan works best with high-deductible option. The money deposited into your account allows you to pay for Medicare and non-Medicare health costs alike. The money left in your account at the end of the year rolls over and is added to the account balance.
What is Medicare Part D?
Medicare Part D offers drug coverage to eligible applicants. However, it is not a part of a Medicare Advantage Plan. Medicare Part D may be a good option if a Part C plan does not provide drug coverage. Because drug plans can vary slightly you must be sure to research coverage options, including generic drugs and drug tiers.
Medicare Part D does work with several insurances including employer health coverage, COBRA, Medicaid and HUD Housing Assistance. Even individuals on food stamps may be eligible for Part D coverage.
What is Medicare Part C coverage for?
A Medicare Advantage Plan such as an HMO or PPO can also be called Medicare Part C. As discussed, this portion of Medicare is offered only through private organizations. If you decide to join an MA plan you can receive the benefits of Part A and B coverage, as well as the part D drug plan.
Traditionally, Medicare will pay a fixed amount every month to these private insurance companies. Because these plans are contracted through Medicare, providers must follow rules established through the program. Costs can vary by Part C plan.
Differences Between Medicare Advantage & Original Medicare
Medicare benefits are available through MA plans or Original Medicare. There are some differences between these two that anyone applying should be aware of.
Original Medicare: This is a traditional program offered directly through the federal government.
- Includes Part A and Part B coverage.
- Medicare limits the amount that can be charged per visit for in-network and out-of-network doctors.
Medicare Advantage Plan: Thee are private plans offered by organizations contracted with the federal government to provide Medicare benefits.
- You will utilize your insurance membership card through the HMO, PPO or PFFS you are enrolled with.
- The plan must offer the same benefits covered by Original Medicare.
- MA Plans apply different rules, costs and medical restrictions than Original Medicare benefits.
- These plans offer benefits that Medicare does not cover.
Medicare enrollment period will differ from the Original Medicare versus the MA plans. Be sure to research late penalties or fees when enrolling. When preparing to do your research, make a list of the coverage you are seeking.
If you were looking for Medicare home health care, nursing home facilities, medical supplies or prescription drug coverage carefully review all plans in which you are eligible. This will ensure which one is the most beneficial. Likewise, if you are managing diabetes or an ongoing condition, then make sure that routine supplies and services are covered.