There are two main ways beneficiaries can get their Medicare coverage: either through Original Medicare (Medicare Part A and Part B) or Medicare Advantage (Medicare Part C). However, you may need to get extra benefits like a Medicare Supplement (Medigap) plan or Medicare Part D prescription drug plan.
If you’re trying to choose a Medicare plan that fits your needs best, keep reading to learn about each plan’s coverage.
Understanding Original Medicare
Original Medicare benefits include two parts – Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). Most beneficiaries get premium-free Medicare Part A coverage, while Medicare Part B has a monthly premium of $148.60 (as of 2021). However, those that earn a higher income pay higher Medicare Part B premiums.
With Original Medicare, beneficiaries can use any provider who accepts Medicare, and coverage from Original Medicare is exactly the same for every individual who enrolls. The coverage includes:
- Inpatient hospital care
- Skilled nursing facility care
- Home health care
- Hospice care
- Provider services
- Durable medical equipment
- Home health services:
- Ambulance services
- Preventative services
- X-rays and lab tests
- Chiropractic care
For prescription drug coverage, you can purchase a standalone Medicare Part D plan. Medicare Part D prescription drug plans are offered by private health insurers approved by Medicare. However, some prescriptions can be covered by Part B if your doctor administers them.
You can also get a Medicare Supplement plan that works alongside your Original Medicare coverage and covers the out-of-pocket costs that Original Medicare leaves behind. Medicare Supplements only work with Original Medicare and cannot be used when enrolled in a Medicare Advantage plan.
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Understanding Medicare Advantage Plans
All Medicare Advantage plans cover everything included in Original Medicare. Some plans also offer coverage for extra benefits, such as:
- Adult day-care services
- Fitness memberships
- Nutrition programs
- Over-the-counter drugs
- Services and supports for those with chronic conditions
- Transportation to doctor visits
- Wellness programs
The most common Medicare Advantage plans are the HMOs and PPOs. HMOs limit their members to using the hospitals and doctors in their provider networks. In contrast, PPO allows its members to receive care outside its network, though you may have to pay more. Some Medicare Advantage plans require prior authorization for special care or procedures and referrals from a primary care doctor.
Also, as mentioned previously, Medicare Supplements cannot be used with Medicare Advantage. This means that the copayments, coinsurance, deductibles, etc., that can be covered with a Medicare Supplement will be left in your responsibility when enrolled in a Medicare Advantage plan.
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Which Is the Best Plan: Original Medicare or Medicare Advantage?
Everyone’s health situation is different, so it isn’t easy to give a simple answer, especially since both Original Medicare and Medicare Advantage can provide different levels of coverage. With this in mind, there are several factors to consider when deciding on coverage, which can include your health status or even travel.
If you frequently travel throughout the country, Original Medicare might be the best option since it does not limit your coverage to a specific service area. As long as the hospital or facility accepts Medicare, you can receive your care. If you travel outside of the country, Original Medicare with a Medicare Supplement plan may be best as some supplement plans provide at least 80% of coverage for foreign travel emergency care.
If you want extra coverage that is not typically covered by Original Medicare, such as dental, vision, or hearing, then a Medicare Advantage plan may be something to consider. You should also keep in mind that you must first be enrolled in Original Medicare before you can enroll in a Medicare Advantage plan.
Speak with a Medicare Expert
In the end, it’s always a good idea to speak to a reputable Medicare insurance expert, like those with Bobby Brock Insurance, to see what Medicare plans are available to you and can fit your lifestyle the best.