Medicare Advantage vs. Original Medicare: What’s the difference?
Knowing the difference between Medicare plans is crucial for people 65.
If you’re 65 or older, choosing a Medicare plan is one of the most important decisions you make each year. For that reason, it’s important to understand the basics of Medicare.
Original Medicare. Medicare Parts A and B are commonly known as Original Medicare. Part A helps cover inpatient care in a hospital or skilled nursing facility, hospice care and home health care. Part B covers doctor visits, preventive care, lab tests, surgery and other outpatient services.
Original Medicare is administered by the federal government with premiums usually being deducted from a person’s Social Security check. Because Original Medicare only covers about 80% of medical bills, many people enroll in a Medicare Advantage or Medigap plan to cover the remainder of those costs.
Medigap. Also known as Medicare supplement plans, Medigap plans cover the 20% of costs not paid by Original Medicare. But they don’t cover additional medical expenses such as vision, hearing, dental or prescription drugs.
Medicare Advantage. Medicare Part C refers to Medicare Advantage plans. They provide all the coverage of Original Medicare but also help pay for additional health and wellness expenses. Depending on which plan you choose, you may have coverage for any combination of dental, vision, hearing and prescription drug benefits.
Choosing the right plan
The true cost of health care is more than just the premium. It’s the premium plus deductibles, copays and out-of-pocket expenses. So, it’s important to pay attention to all these costs when choosing a plan. Here are some things to consider:
- $0 premiums. Some insurers, including HAP, offer Medicare Advantage plans with $0 monthly premiums. This is a good way to get the additional benefits of a Medicare Advantage plan without any additional monthly costs.
- $0 copays. Does your plan cover all the costs associated with office visits, annual physicals or telehealth services? Or are you responsible for a copay? There are Medicare Advantage plans that offer $0 copays for these services, as well as for annual dental, vision and hearing exams.
- Over-the-counter allowance. Do you wish you had help paying for over-the-counter medications such as aspirin or cough and cold remedies? What about that blood pressure cuff you need to monitor your blood pressure at home? Look for an insurer who offers an over-the-counter benefit that will cover the costs of these necessary (but often expensive) items.
- Travel coverage. If you like to travel, keep in mind that while Original Medicare is accepted by any Medicare-participating doctor in the country, coverage outside the U.S. is limited. If this is important to you, look for a Medicare Advantage plan that offers coverage abroad.
- Fitness benefits. If staying healthy and fit is important to you – and it should be – look for a plan that offers fitness benefits such as free or reduced gym memberships.
Finally, remember that Medicare Advantage and Medicare supplement plans are only available through health insurance companies or agents licensed to sell Medicare plans.
To get more information on Medicare plans, visit HAP.org.
ABOUT THE EXPERT
Margaret Anderson is senior vice president, chief sales and marketing officer for Health Alliance Plan (HAP). She is responsible for HAP’s strategic planning, as well as sales and service for all product lines. She has more than 25 years of experience in the health care industry, with a focus on serving the unique needs of the Medicare population.
Members of the editorial and news staff of The Detroit News were not involved in the creation of this content.