Medicare Original vs Medicare Benefit: What’s the Difference?

Sponsored: People 65 and older can choose between Original Medicare and Medicare Advantage, but how are the two plans different?

(University of Utah Health Plans) | Medicare Original vs Medicare Benefit: What’s the Difference?

If you are 65 or older, you can choose between the original version Medicare or Medicare Advantage, But what is the right health plan for you? Here, the two types of Medicare are explained, so when it’s time to choose between plans, you can make an informed decision.

What is Medicare? It is a federally funded health insurance program for individuals 65 years of age or older. You first qualify to enroll in Medicare three months before your 65th birthday, however, if you have a disability, ALS (also known as Lou Gehrig’s disease) or end-stage kidney disease (ESRD), you may be eligible for Medicare until sooner.

Medicare Basics

Your Medicare options include Original Medicare (a federal government health insurance plan) and Medicare Advantage (Private insurance alternative to the federal version). Original Medicare includes Part A and Part B, and Medicare Advantage is known as Part C.

Original Medicare (Parts A and B only)

Part A (hospital insurance): This part helps cover:

Part B (Medical Insurance): This part helps cover:

  • Services from medical providers

  • Outpatient services

  • home health care

  • Durable medical equipment, such as walkers, wheelchairs, hospital beds, etc.

  • A variety of preventative services, such as check-ups, vaccinations, and annual wellness visits

* Medicare Parts A and B do not cover: prescription drugs, most dental services, dentures, hearing aids, long-term care, or eye exams.

Part C (Medicare Benefits)Medicare Advantage (also called Part C) is an alternative to the original Medicare program approved by Medicare, but issued by a private insurance company.

Medicare can be thought of as a “bunched plan” that typically includes Part A, Part B, and Part D (drug coverage). Medicare Advantage plans may provide additional benefits not available with original Medicare, including: dental, vision, and hearing.

Part D (Drug Coverage): This is separate and not part of the original Medicare program. This part helps cover the costs of prescription drugs, many injections and vaccines.

  • If you want drug coverage, you must join a drug plan in addition to original Medicare, or get drug coverage by joining a Medicare Advantage plan with drug coverage.

  • Plans that include Medicare drug coverage are issued by private insurance companies that follow the rules set by Medicare.

Key Differences Between Original Medicare and Medicare Advantage

When you enroll in Medicare, you choose between Original Medicare and Medicare Advantage – Original Medicare essentially offers fewer Medicare Advantage benefits. The good news is that you can sign up for one, but you’re not stuck with that. If your circumstances change, you always have the option to switch plans.

Original MedicareThis plan includes Parts A and B, and you can join a separate plan to receive Medicare drug coverage (Part D). With original Medicare, you can use any doctor or hospital in the United States that deals with Medicare.

Original Medicare charges a premium based on your income and has 20 percent coinsurance, but to help pay for your out-of-pocket costs, you can buy supplemental coverage, such as Medigap, or you can get coverage from Medicaid, a former union or employer. Original Medicare does not have an out-of-pocket limit.

Medicare Advantage (Plan C): This plan is an alternative to the original Medicare program approved by Medicare, but issued by a private company; It includes Part A, Part B, Part D, and may cover teeth, hearing, and vision.

Medicare Advantage sometimes has a premium, but many plans have $0 monthly premiums (you pay a premium to cover Part B). While the original Medicare program charges a 20 percent co-fee, Medicare Advantage plans sometimes do this; With these plans, you can choose how much co-insurance you pay for different services. Once you reach the limit, Medicare Advantage pays the full cost of your care.

Coinsurance refers to the percentage of covered health care costs that a person has to pay after they have paid the deductible. For example, let’s say your health insurance allows $100 for an office visit and your coinsurance is 20 percent. Once you pay the deductible, you’ll pay 20 percent of the $100, which would be $20.

With Medicare Advantage, you generally need to use doctors within your plan’s network. If you travel out of state frequently; For example, to visit your adult children or grandchildren, this may be a consideration when deciding between Original Medicare and Medicare Advantage.

In short: Original Medicare includes only Parts A and B. Parts C and D are called “Medicare Advantage” and this plan covers everything that original Medicare covers but, in addition, may include coverage for medications, routine dental benefits, and vision and hearing. One of the main advantages of Medicare Advantage is that these plans may have lower out-of-pocket costs than original Medicare plans.

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