Medicare 101: Medicare Advantage vs. Original Medicare

Medicare Advantage vs. Original Medicare

When it comes to enrolling in Medicare, there are two main options: Original Medicare and Medicare Advantage. Understanding the difference will help you choose the right plan for your needs. We’ve highlighted key differences to help you evaluate your options and make sure you have the coverage you need, when you need it.

Original Medicare - Covers Part A & Part B

Coverage by the federal government

Services Covered

• Covers hospital (Part A) and outpatient doctor and medical services (Part B) costs only.
• Does NOT include prescription drug, dental, vision or hearing coverage or provide extra supplemental benefits.

Premium (the monthly plan cost)

• Part A monthly premium: $471.00. Most people don't pay a Part A premium due to paying Medicare taxes while working.
• Part B monthly premium: $148.50. Watch out for the Part B late enrollment penalty - a penalty that applies if you don't sign up for Part B when you're first eligible or don't meet other conditions for late enrollment.

Deductibles (the amount of money you have to pay before your plan starts paying towards your costs)

• Part A deductible: $1,484.00
• Part B deductible: $203.00

Coverage and Cost of Care

• Covers 80% of approved healthcare costs after meeting your deductible.
• You are responsible for paying the other 20% of the approved amount for services.
• There is no limit to the amount you could pay.

Out-of-Pocket Maximums

• No limit to what you could pay out-of-pocket.
• Medicare only pays for a limited number of days in the hospital or skilled nursing facility.

Drug Coverage (also known as Part D)

• Does NOT include drug coverage.
• A separate prescription drug plan is needed, at an additional cost.
• Watch out for Part D late enrollment penalty - a penalty that applies if you don't sign up for drug coverage or have other creditable drug coverage when you're first eligible.

Referrals

• A referral is not required to see a specialist with this plan.

Network

• You can see any provider or facility that accepts Medicare.

Travel Coverage

• Except in extremely rare cases, Medicare doesn't cover care received when you're out of the country, even in an emergency.

Medicare Advantage - "All-in-one" plans

Coverage by private companies approved by the federal government, like MyTruAdvantage

Services Covered

• Covers everything that Original Medicare covers (Parts A & B), plus more.
• Many Medicare Advantage plans also include prescription drug, dental, vision and hearing coverage, and extra benefits like gym memberships, over-the-counter allowances and more.
• Medicare Advantage plans are also referred to as Part C.

Premium

• Many plans have low-cost premiums, with some plans even having $0 premiums. *You must still pay the monthly Part B premium, in addition to your plan premium.

Deductibles (the amount of money you have to pay before your plan starts paying towards your costs)

• Many plans have $0 or low deductibles for medical services and generic prescription drugs.

Coverage and Cost of Care

• Coverage and cost-sharing varies depending on plan.
• You usually pay a copayment to receive care.

Out-of-Pocket Maximums

• Includes an out-of-pocket maximum each year.
• Once you pay a certain amount, the plan pays 100% of the cost for most covered services.

Drug Coverage (also known as Part D)

• Many Medicare Advantage (MA) plans include drug coverage. These are called MAPD Plans.

Referrals

• Many plans do not require a referral to see a specialist.

Network

• Some plans require you use providers and facilities in-network (i.e., HMO plans).
• Some plans do not require you to use a specific network (i.e., PPO plans). With these plans you can see any provider or facility that accepts Medicare.

Travel Coverage

• Most plans cover emergency care when you're out of the country, including emergency care up to a lifetime maximum amount.

Regardless of whether you choose Original Medicare or a Medicare Advantage plan, remember you’ll want to enroll in Medicare (Parts A & B) when you’re first eligible—sometime between the 3 months before and the 3 months after you turn 65—to avoid paying penalties later.

As a leading provider of healthcare services, we often receive questions from our patients about Medicare. As an owner of MyTruAdvantage Medicare Advantage Plan, we created this Medicare 101 series to help provide helpful information about options available to you when it comes to your healthcare coverage.

MyTruAdvantage is Indiana’s own community-focused Medicare Advantage plan. MyTruAdvantage is a Medicare Advantage plan founded by local doctors and hospitals you know and trust like Community Health Network and designed around you and your needs.

 

To learn more about Medicare and MyTruAdvantage Medicare Advantage plans, visit www.MyTruAdvantage.com or call 833-213-6731 (TTY: 711).