Differences Between Original Medicare and Medicare Advantage Plans

Also called Medicare Part C, Medicare Advantage plans are Medicare-approved private insurance plans that offer an alternative to Original Medicare. These plans combine coverage for hospital stays, physician visits, and other medical services in one comprehensive plan that offers all of the benefits provided by Medicare Parts A and B (except hospice care). Many Medicare Advantage plans also include prescription drug coverage and other benefits like routine vision and dental care.

If you are considering enrolling in a Medicare Advantage plan, here are the key choice, cost, and coverage differences between them and Original Medicare:

Doctor and Hospital Choice

• Original Medicare: You can go to any U.S. physician or hospital that takes Medicare, and in most cases, you won’t need a referral to visit a specialist.
• Medicare Advantage: In many cases, you can only see doctors and other providers in the plan’s network (for non-emergency care). You may also need a referral to see a specialist.

Out-Of-Pocket Costs

• Original Medicare: For services covered by Medicare Part B, you’ll pay a monthly premium and usually pay coinsurance of 20 percent of the Medicare-approved amount for services after meeting your deductible. If you choose to enroll in a Medicare drug plan (Part D), you’ll pay a separate premium. There’s no annual limit on your out-of-pocket costs unless you have Medicare supplemental coverage, which you can use to cover remaining out-of-pocket expenses.
• Medicare Advantage: Out-of-pocket costs vary – plans may have different out-of-pocket expenses for certain services. In addition to paying the monthly Part B, you may also have to pay the Medicare Advantage plan’s premium, though some plans have a $0 premium. Most Advantage plans include Part D Medicare drug coverage and place a yearly limit on out-of-pocket costs for services covered by Medicare Part A and Part B. Once you reach your plan’s limit, you’ll pay nothing for the rest of the year for services covered by Part A and Part B.

Scope of Coverage

• Original Medicare: Original Medicare covers most medically necessary services in hospitals, physicians’ offices, and other health care facilities but does not cover eye exams, most dental care, and routine exams. You can join a separate Medicare drug plan to get Medicare drug coverage (Part D).
• Medicare Advantage: Plans must cover all of the medically necessary services that Original Medicare covers. Most plans offer extra coverage that Original Medicare doesn’t provide – like some routine exams and vision, hearing, and dental services. Most plans also include Part D Medicare drug coverage

Contact Every Way Health To Learn More About Medicare Advantage Plans

If you want to learn more about Medicare Advantage plans or need assistance choosing the plan that’s best for you, please get in touch with Every Way Health at 877-460-3943.

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