Friday, November 22

Time to review Medicare Advantage

If you want to enroll in Medicare Advantage for the first time, or you are already in the program but want to change plans, this is the time. You have until 31, when the open enrollment period ends.

You can also, if you consider that it is convenient to return to Original Medicare during this period.

Most Medicare beneficiaries modify their plans because their doctors are no longer in that plan, or because they no longer cover the drugs they need .

If you have questions, and to help you decide, the following are some comparisons between Original Medicare and Medicare Advantage in terms of general characteristics, coverage and costs.

In an overview, the main characteristics of both plans are:

Original Medicare

  • Includes Part A (hospital insurance) and Part B (medical insurance).
  • If you want drug coverage, you can have separately a Part D plan.
  • To help with out-of-pocket expenses (such as 20% of coinsurance), you can also buy a supplemental coverage (for example Medigap).
  • You can go to any doctor or hospital that accepts Medicare, anywhere in the United States.
  • In most cases, you do not need an order from your primary care physician to see to a specialist.

Medicare Advantage

  • Offers a “single window” with bundled plans that include Part A and Part B, and generally Part D.
  • These plans may have lower out-of-pocket costs than Original Medicare.
  • In most cases, you will need to use doctors who are in the plan’s network.
  • Most plans offer extra benefits that Original Medicare doesn’t cover, such as, vision, hearing, dentistry and more.
  • You may need a warrant 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 that of the costs of both plans.

Original Medicare costs

  • For Part B of services, you will usually have to pay a 20% , until you reach your deductible.
  • You pay a premium for part B, and another for part D, if you so decide, to have drug coverage.
  • There is no limit annually on what you pay out of pocket unless you have coverage (like a Medigap policy).
  • You can get supplemental coverage (like a Medigap policy) to help pay remaining out-of-pocket costs (such as 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 may sometimes be lower than Original Medicare.
  • You can pay a premium for the plan in addition to a monthly premium for Part B. (Most include prescription drug coverage). Plans can have a $ 0 premium or can help pay all or part of Part B premiums .
  • Plans have an annual limit on what you pay out of pocket for services covered by Medicare Part A and B . Once you reach your plan limit, you will not pay anything for the services covered by Part A and Part B by the rest of the year.
  • You cannot buy 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 spaces .
  • You can purchase a separate Part D plan to cover your medications.
  • In most cases, you do not need to obtain pre-approval for a service or supply to to be covered.

Medicare Advantage Coverage

  • Plans must cover all medically necessary services that Original Medicare covers. Most plans can offer extra benefits that Original Medicare doesn’t cover, like vision, hearing , dentist and others. Plans can now cover more of these benefits than in the past.
  • Drug coverage is included in most plans.
  • In some cases, You must get a service or supply approved in advance to be covered by the plan.

Sources: medicare.gov, CMS.