Benefits of original Medicare and Medicare Advantage
Seeking original Medicare insurance to cover healthcare requirements is imperative for each individual. But at the same time, one also has the option of choosing Medicare Advantage, which is a private insurance alternative. Both types have their own benefits that may or may not work for you. So before picking one over the other, here are a few factors to determine whether the federal-run or private insurance program is more beneficial.
Out-of-network coverage
If you pick original Medicare, you need to follow the premium guidelines set by the federal government. These include deductibles and coinsurance amounts for Part A (hospitalizations) and Part B (physician and outpatient services). Furthermore, the government sets maximum deductible rates for Part D prescription programs (premiums and copays may differ based on the plan). You should also bear in mind that several beneficiaries of original Medicare usually purchase a supplemental (or Medigap) policy to ease their out-of-pocket costs, which have no annual cap.
If you pick a Medicare Advantage plan, you will still need to pay the Part B premium set by the federal government. You may also need to pay an additional premium for the Medicare Advantage plan. However, most of these plans have fixed copay amounts from the expenses associated with physician visits, which could result in lower out-of-pocket costs in comparison to original Medicare.
Costs
When you subscribe to original Medicare for Part B-covered services, you usually have to pay 20% of the Medicare-approved amount after you meet the deductible, known as the coinsurance. You may also have to pay a monthly premium for Part B and a standalone amount for a Medicare prescription plan (Part D). Furthermore, there is no yearly cap on what you pay out-of-pocket. However, you may incur additional costs for supplemental coverage like Medigap.
As for Medicare Advantage, the out-of-pocket cost may vary. Some plans may require you to pay more for certain healthcare expenses, while others may require less. Therefore, you must check each insurance offer before signing up for it. Under Medicare Advantage, members need to pay the plan's premium while paying the monthly Part B premium. A few plans may have a $0 premium charge and could help cover part or all of your Part B premiums. Most MA plans include Medicare prescription coverage (Part D). Moreover, the plans come with a yearly cap on how much you pay out of pocket for services covered by Medicare Part A and Part B. Once the plan's limit is reached, you do not have to pay for services Part A, while Part B will cover amounts accrued through the rest of the year.
Coverage
Original Medicare covers most healthcare-oriented services and supplies in doctors, hospitals, offices, and other healthcare facilities. One should note that this federal program may not cover benefits, including dental care, eye exams, and routine exams. You also have the option of joining a Medicare prescription plan to receive benefits under Part D. One should also note that most healthcare situations do not require advance approval of service or supply.
Those who pick a Medicare Advantage plan typically receive all healthcare-related services that original Medicare covers. The insurance may also offer additional benefits not covered by Medicare, such as vision, dental, and hearing services. MA plans may also include coverage for Medicare Part D. Once an individual signs up for Medicare Advantage, they may not be able to join a separate Medicare prescription plan. And unlike original Medicare, they may need to get a service or supply approved ahead of time so that the respective plan can cover it.
Coverage in the country
If you sign up for original Medicare, you will get access to health care anywhere in the country. This is applicable as long as the provider accepts the federal program. So this could work for those who travel between states a lot.
Medicare Advantage plans are based around networks of providers, usually self-contained in a specific geographic area. Therefore, healthcare might not be covered if you visit out-of-network providers. You may also have to pay more for care.
Foreign travel
Both original Medicare and Medicare Advantage generally do not cover healthcare requirements outside the country. Those who pick the first choice may be able to buy a Medicare Supplement Insurance (Medigap) policy to cover emergency care outside the country. One could also look at supplemental benefits that take care of urgent and emergency services under Medicare Advantage while traveling outside the country.
Eligibility and signing up
To qualify for original Medicare (Part A and Part B), one has to be age 65 or older. The plan is also accessible to certain younger people with disabilities and other individuals with End-Stage Renal Disease. Most qualifying people get Part A for free, but some may have to pay a premium for the coverage. People who already receive Social Security or RRB benefits at least four months before being eligible for Medicare and residing in the country are automatically enrolled in premium-free Part A and Part B. They also have the choice to keep or refuse Part B coverage following enrollment.
People who have original Medicare are eligible for a Medicare Advantage plan. Furthermore, those under 65 due to disabilities and who have Medicare also qualify for the program. You may sign up for a Medicare Advantage policy if you reside in the chosen plan's service area. If you enroll in a MA plan, you have to pay its monthly premium in addition to your Medicare Part B premium.
