When choosing between Original Medicare and a Medicare Advantage Plan for your health coverage, take these factors into consideration:
Medicare is a government-run health insurance program that provides coverage for hospital and medical services, while Medicare Advantage is a privately offered alternative that combines Medicare Parts A and B with additional benefits and often includes prescription drug coverage.
Doctor & hospital choice
In most cases you don’t need a
referral to see a specialist.
You may need to get a referral to see a specialist.
You can go to any doctor or hospital that takes Medicare, anywhere in the U.S.
For non-emergency care, it is often necessary to use doctors and other providers who are within the network and service area of the plan in many cases.
After meeting your deductible, for Part B-covered services, you typically pay 20% of the Medicare-approved amount as your coinsurance.
The out-of-pocket costs for certain services can vary between plans, with some plans having lower or higher costs. Additionally, you may be required to pay an additional premium.
There is a monthly premium for Part B that you have to pay. If you decide to enroll in a Medicare drug plan, you will have to pay a separate premium for your Medicare drug coverage (Part D).
You are responsible for paying the monthly premium for Part B, and in addition, you may need to pay the premium for your specific plan. Certain plans have a $0 premium and may even assist in covering all or a portion of your Part B premium. Furthermore, most plans include Medicare drug coverage (Part D).
Unless you have supplemental coverage such as Medicare Supplement Insurance (Medigap), there is no annual limit on your out-of-pocket expenses.
For services that are covered by Medicare Part A and Part B, there is an annual out-of-pocket limit set by the plans. Once this limit is reached, you will not have to pay anything for the remaining covered services for the rest of the year.
To assist with covering your remaining out-of-pocket costs, such as the 20% coinsurance, you have the option to purchase Medigap. Alternatively, you can utilize coverage from a previous employer or union, or rely on Medicaid.
You can’t buy Medigap.
Original Medicare provides coverage for a wide range of medically necessary services and supplies in hospitals, doctors' offices, and other healthcare facilities. However, it does not cover certain benefits such as eye exams, most dental care, and routine exams.
Plans must cover all medically necessary services that Original Medicare covers. Plans may also offer some extra benefits that Original Medicare doesn't cover - like certain vision, hearing, and dental services.
You have the option to enroll in a standalone Medicare drug plan in order to obtain Medicare drug coverage (Part D).
Medicare drug coverage (Part D) is included in most plans. In most types of Medicare Advantage Plans, you can't join a separate Medicare drug plan.
In most cases, you don’t need approval for Original Medicare to cover your services or supplies
In many cases, you may need to get approval from your plan before it covers certain services or supplies.
Original Medicare does not provide coverage for medical care received outside of the United States. However, you may be eligible to purchase a Medicare Supplement Insurance (Medigap) policy that includes coverage for emergency care received while outside of the U.S.
Plans generally don’t cover medical care outside the U.S. Some plans may offer a supplemental benefit that covers emergency and urgently needed services when traveling outside the U.S.
Original Medicare and Medicare Advantage coverage function in different ways, and choosing the right coverage option depends on your specific situation. To make an informed decision, it is advisable to seek help from a knowledgeable professional. Lehigh Partners Senior Benefits offers the expertise of their agents who can assist you in selecting the most suitable coverage choice for your needs. They can be reached conveniently through phone or online communication.