Original Medicare Vs Medicare Advantage: Everything You Need To Know

When you turn 65, the federal government bestows certain health care benefits that aim to deliver a hassle-free medical experience. But the good news is that several plans have been introduced to add flexibility, so you may choose the ones that fit your pocket. So is it original Medicare vs Medicare Advantage for you?

When it comes to healthcare insurance, the costs come as a significant factor in limiting the choices. Apart from the premiums, there are coinsurance, deductibles, and copays in calculating the total Medicare expenses. If you want drug prescription and provider networks, you need to consider the factors as an adage into your usual plan.

So, let’s take a look at both Medicare and Medicare Advantages, so you can choose the one that’s right for you.

Original Medicare

As mentioned above, the original Medicare was a healthcare program initiated in 1965 by the government to aid seniors with hospital and medical costs. It mainly consists of two parts: Part A and Part B.

Part A is your hospital insurance and covers your expenses for care at skilled nursing facilities and nursing homes. If your work history qualifies, you get free premiums for Part A. As for Part B, it is usually the medical insurance that covers preventive care, visits to the doctor, durable medical equipment, lab tests, and so on. Also, the premiums for Part B are set each year by the federal government, where people pay the same standard rate.

Both parts come with coinsurance, copayments, and deductibles for most services. However, when it comes to drug prescription for original Medicare vs. Medicare Advantage, the original one doesn’t offer coverage, but you can get a separate prescription plan. This will be your pharmacy card, where you get prescription drug plans offered by insurance companies.

Medicare Advantage

As the name indicates, it gives you an advantage of availing plans other than Plan A or Plan B. The insurance companies provide Medicare plans with edges, which include benefits like drug prescription, routine dental, hearing care, and so on.

If you are to compare Medicare advantage plans side by side with the original Medicare, you will see that the number of people enrolled in Medicare Advantage plans has multiplied three folds since 2003.

However, to be eligible for Medicare advantages, you must be enrolled in Medicare Part A and Part B. You must live in the area where you are receiving the service and must not have serious renal disease. You must also pay your Medicare Part B premium along with the plan premium if there’s one.

Medicare Advantage plans vary according to the options they provide. The most popular ones are listed below:

Health Maintenance Organizations (HMOs) – these have closed provider networks with all the emergency care included in your plan. These always have Part D included in the drug coverage.

Preferred Provider Organizations (PPOs) – you can find provider networks here, but you can choose any outside provider that accepts Medicare. But if you stay within your system, you won’t have to pay hefty out-of-pocket costs. Part D is included in some PPOs.

Difference And Comparison

While Medicare Advantage offers added benefits for the enrollers of Medicare, here is a comparison between what each provides.

Covered services – your Medicare covers Part A and Part B. Along with these, additional services are included in Medicare Advantage.

Prescription Part D – Medicare doesn’t usually include a drug prescription plan, while Medicare Advantages consists of this option in most of its plans.

Choice of doctor – you can choose your doctors in both kinds. But for Medicare Advantage, you may be required to use the doctor in your plan’s network.

Extra benefits – Medicare is limited in this respect. However, Medicare Advantages offers several benefits varying from one plan to another.

Travel outside the USA – original Medicare offers travel outside the USA, but in Medicare Advantage plans, you only get to travel abroad in emergency cases.

Deductibles – both offer deductibles, but in Advantage plans, not all plans may offer them.

Coinsurance or copays – both include copays and coinsurance for most services.

Premiums – both parts in Medicare offer monthly premiums, but in Advantage plans, some plans have $0 premiums while some require you to pay Part B monthly premiums as well.

Annual maximum out-of-pocket limit – Medicare doesn’t provide coverage for annual out-of-pocket expenses. On the other hand, Advantage plans do have a maximum out-of-pocket limit, but that varies from plan to plan.

What’s Right For You: Medicare vs. Medicare Advantage 2020

When it comes to original Medicare vs Medicare Advantage plans, the latter may seem like the best choice. That, however, is not the actual case. You may switch from the original to the advanced options and vice-versa. But before you choose Medicare or Advantage plans, you must first consider the overall costs, such as premium, coinsurance, copays, and deductibles.

If you are choosing plans, you may also consider if the plans you’re considering refer to your health conditions. Always make sure that you have money set aside to cover the copays and coinsurance in case you have to deal with a chronic illness.

If you travel often, your choice of plan may also differ in its scope. You may probably need the original Medicare plan to find the best bet. For people who are budgeting, Medicare Advantage may offer the convenience of a Part D drug plan.

However, it’s better always to consult a professional Medicare insurance agent to see and decide what’s available in your area. They might walk you through the process, so you can better understand what fits your requirements perfectly.