One of the most important decisions you have to make before you turn 65 is what type of Medicare plan you decide to join. There are options. And you should know the differences to see which one best suits your health needs.
It’s also important to know them in case you want to make changes to your coverage in the future.
Original Medicare
- Includes Part A (hospital insurance) and Part B (medical insurance).
- If you want drug coverage, you can have a separate Part D plan.
- To help with out-of-pocket costs (such as 20% coinsurance), you can also purchase supplemental coverage (such as Medigap).
- You can go to any doctor or hospital that accepts Medicare, anywhere in the United States.
- In most cases, you don’t need an order from your primary care doctor to see a specialist.
MedicareAdvantage
- It offers a “single window” with bundled plans that include Part A and Part B, and usually Part D.
- These plans may have lower out-of-pocket costs than Original Medicare.
- In most cases, you must use doctors who are in the plan’s network.
- Most plans offer extra benefits that Original Medicare doesn’t cover, like vision, hearing, dental, and more.
- You may need an order to see a specialist.
The possibility of seeing any doctor participating in the program or going to any hospital is for many an advantage of Original Medicare over Medicare Advantage.
Especially with the increase in age-related medical conditions.
Another important comparison to make is the costs of both plans.
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Original Medicare costs
- For Part B services, you will usually have to pay 20%, until you reach your deductible.
- You pay a premium for Part B, and another for Part D, if you choose, for drug coverage.
- There is no annual limit on what you pay out of pocket unless you have coverage (such as a Medigap policy).
- You can get supplemental coverage (like a Medigap policy) to help pay for remaining out-of-pocket costs (like your 20% coinsurance). Or you can use coverage from a former employer or union, or Medicaid.
Medicare Advantage Costs
- Out-of-pocket costs vary and can sometimes be lower than Original Medicare.
- You may pay a premium for the plan in addition to a monthly premium for Part B. (Most include prescription drug coverage.) Plans may have a $0 premium or may help pay all or part of Part B premiums.
- Plans have a yearly limit on what you pay out-of-pocket for Medicare Part A and B covered services. Once you reach your plan limit, you pay nothing for Part A and Part B covered services for the rest of the year.
- You cannot purchase or use supplemental coverage.
Finally, the essential differences in coverage
Original Medicare coverage
- Original Medicare covers most services and supplies needed in hospitals, doctor’s offices, and other health care settings.
- You can purchase a separate Part D plan to cover your medications.
- In most cases, you don’t need to get approval in advance for a service or supply to be covered.
Medicare Advantage Coverage
- Plans must cover all medically necessary services that Original Medicare covers. Most plans may offer extra benefits not covered by Original Medicare, like vision, hearing, dental, and more. Plans may now cover more of these benefits than in the past.
- Drug coverage is included in most plans.
- In some cases, you must get an approved service or supply in advance for it to be covered by the plan.
