Last Updated on February 27, 2024
Even after you learn that there is a distinction between Medicare and Medicaid, it can still be a bit confusing to discover that there is more than one form of Medicare. This article has been written so that the American public can be better informed about Medicare Advantage and how it differs from Original Medicare.
How is an Advantage Separate?
Medicare is divided into four components: Medicare Part A, Part B, Part C (also called Medicare Advantage), and Part D for prescription drugs. Medicare Advantage is its own thing, there are several plans that blend Part A (the part that covers your hospital bills), Part B (the part that covers your medical bills), and a variety of other benefits in one single plan. While Original Medicare will not cover any costs that are related to prescription drugs nor grant additional health benefits, many Medicare Advantage plans do furthermore, the additional coverage granted by Part C includes things like dental, fitness, hearing, and vision plans.
Where Does the Funding Come From?
Medicare is federal health insurance for people 65 or older, some younger people with disabilities, people with End-Stage Renal Disease. Original Medicare is a federal program, meaning that its coffers are filled by the American taxpayer. Medicare Advantage, by contrast, is handled by insurance companies within the private sector. This means that you are the one who pays more to stay solvent while dealing with a variety of medical circumstances. As such, there is a vast array of different plans to handle Medicare Part C, each offering different features, costs, and coverage based on the company and where you live.
How Does Coverage Differ?
In addition to the prior overview, it is worth mentioning that some Medicare Advantage plans also cover Part D (the section that deals with prescription medications).
What Affects the Cost?
A Medicare Advantage plan’s cost will depend on several factors:
- Part B premiums.
- Low- or $0-cost plan premiums.
- A deductible. Though not all Medicare Advantage plans have one.
- Copays for covered services and items.
It is also worth mentioning that Medicare Advantage has a ceiling to out-of-pocket costs, giving you a greater degree of control over your Medicare costs. Original Medicare has no such ceiling of financial safety.
Who Provides Care With Medicare Advantage?
Original Medicare lets you go to any hospital and see any doctor in the country, so long as the place accepts Medicare. There is an additional but limited amount of coverage regarding seeking treatments in foreign countries.
Most Medicare Advantage plans will give you a specific list of doctors and providers that they will deal with, known as a “network.” Going outside of this network is more than likely going to cost more than receiving care from within it. Note that emergency services and urgent care facilities are covered throughout the entire country. While there is also a limited amount of coverage when seeking treatment outside of the United States, some Part C plans may involve special foreign coverage or other benefits related to traveling. To learn more about Medicare Advantage visit this page.
Original or Advantage. Which is Best?
There are three main questions you should ask when considering whether or not Medicare Advantage is worth pursuing.
1. Do you value a dental plan, vision plan, or other additional care?
The most basic distinction between Original Medicare and Medicare Advantage is that the latter can be used to cover procedures and treatments that the former ignores. If you need to have your eyes or smile worked on, you will likely save a fair amount of money by going through Part C.
2. What Do You Want Your Total Costs to Be?
Your total costs are dependent upon your coverage and the services you use.
- Medicare Advantage has a threshold for how much it asks you to pay out-of-pocket. Doing so with Original Medicare entails investing in a supplemental Medicare plan and only by so much if you do.
- Advantage plans are likely going to have lower premiums than Original, especially if you add a Part D prescription drug plan to things.
- Medicare Advantage allows more copays than Original Medicare but this fact can be modified by whether or not the treatment is within your network.
3. How Often Do You Leave the Country?
While Original Medicare works with any Medicare-accepting provider in the United States, Medicare Advantage plans require you to analyze your network to avoid supplemental costs and fees. Anyone who does a great deal of traveling should carefully measure how their Medicare coverage will be affected.
It Is Not a One-and-Done Decision
Regardless of whether someone chooses to enroll in Original Medicare or Medicare Advantage, they are not locked into that decision for the rest of their life. There are only two situations where a person can change their plan: the Annual Enrollment Period and the Special Enrollment Period for qualifying life events like moving, losing a partner, etc.