Original Medicare vs. Medicare Advantage

When it comes to deciding whether to enroll in Original Medicare or Medicare Advantage, there are many factors to consider. In this post, we’ll outline the key differences between the…

September 1, 2022

Written by @Developer

When it comes to deciding whether to enroll in Original Medicare or Medicare Advantage, there are many factors to consider. In this post, we’ll outline the key differences between the two options so that you can make an informed decision. Keep in mind that these descriptions are generalizations, and each person’s situation may be different.

What Is Medicare?

Medicare is a federal health insurance program that covers people 65 and older and some younger people with disabilities. Medicare has four parts: Part A, Part B, Part C, and Part D.

 

Most people who have worked for at least ten years in the United States are automatically enrolled in Medicare Part A when they turn 65. If you are not automatically enrolled, you can sign up for Medicare through the Social Security Administration.

 

Medicare Parts B and D are optional and require a monthly premium. You can enroll in these parts of Medicare through the Social Security Administration or a private company that contracts with Medicare.

Benefits Of Original Medicare

Original Medicare, also known as fee-for-service Medicare, includes Part A and Part B.

Part A covers inpatient hospital care, skilled nursing facility care, hospice care, and some home health care.

 

Part B covers outpatient services such as doctor’s visits, preventive screenings, durable medical equipment, and some home health care.

 

Original Medicare does not cover prescription drugs, so most people who enroll in Original Medicare also enroll in Part D to get drug coverage.

Drawbacks Of Original Medicare

One of the biggest disadvantages of Original Medicare is that it does not cover everything. In addition to not covering prescription drugs, it also does not cover dental or vision care.

 

Another drawback of Original Medicare is that it does not have a yearly limit on out-of-pocket expenses. This means that if you have high medical costs in a given year, you could end up paying a significant amount of money out of pocket.

Enrolling In Original Medicare

If you are automatically enrolled in Medicare Part A, you will receive your red, white, and blue Medicare card in the mail about three months before your 65th birthday. If you are not automatically enrolled in Part A or want to enroll in Part B, you can sign up for Original Medicare during your Initial Enrollment Period.

 

Your Initial Enrollment Period is a seven-month span that begins three months before you turn 65, including the month you turn 65 and ends three months after you turn 65.

 

You can also sign up for Part A and Part B at any time if you meet certain conditions, such as having an end-stage renal disease or being disabled.

What Does Original Medicare Cover?

Original Medicare is the government-sponsored health insurance program for people 65 and older. It includes two parts: Part A (hospital insurance) and Part B (medical insurance). Together, these cover a range of medical services and supplies, from doctor visits to inpatient care.

 

Part A typically covers hospital stays, while Part B covers things like outpatient care, preventive services, and some medical equipment. You can also add extra coverage, known as Medigap or a prescription drug plan (Part D), to help pay for things that Original Medicare doesn’t cover.

 

While some costs are associated with Original Medicare (like premiums, deductibles, and coinsurance), it does provide broad coverage. This can be a good option if you want to keep your own doctor or aren’t comfortable with managed care.

Original Medicare Requirements

To be eligible for Original Medicare, you must be a U.S. Citizen or permanent legal resident, 65 years or older. If you are younger than 65, you may still qualify if you have certain disabilities, End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS).

 

If you’re already receiving benefits from Social Security or the Railroad Retirement Board (RRB), you will automatically be enrolled in Part A and Part B at age 65. If not, you can sign up during your Initial Enrollment Period (IEP), which is the seven-month period that begins three months before your 65th birthday and ends three months after it. You can also enroll outside of your IEP if you qualify for a Special Enrollment Period (SEP).

 

You must pay your Part B premium each month to keep your coverage. If you decide to cancel your coverage, you can do so at any time. However, if you want to re-enroll in the future, you may have to pay a late enrollment penalty.

What Is Medicare Advantage?

Medicare Advantage is a type of Medicare Part C. It’s an alternative to Original Medicare that private insurance companies offer. If you enroll in a Medicare Advantage plan, you will still have Medicare Parts A and B, but your coverage will be through the private insurance company instead of Original Medicare.

Benefits Of Medicare Advantage

Medicare Advantage plans, also known as Part C, are an alternative to Original Medicare. Private insurance companies offer these plans and must provide at least the same level of coverage as Original Medicare.

 

One of the main benefits of enrolling in a Medicare Advantage plan is that you may see a lower out-of-pocket cost than you would with Original Medicare. This is because most Medicare Advantage plans offer additional coverage, such as prescription drug coverage or dental and vision coverage, that Original Medicare does not cover.

 

Another benefit of enrolling in a Medicare Advantage plan is that you may have more flexibility in choosing your doctors and other health care providers. This is because most Medicare Advantage plans have networks of doctors and other health care providers that you can see without paying a penalty.

 

However, many Medicare Advantage plans offer additional benefits, like prescription drug coverage (Part D), dental, and vision. Some plans also have $0 premiums and lower out-of-pocket costs. Medicare Advantage plans typically use networks of doctors and other providers, so it’s important to make sure your favorite providers are in the network before you enroll.

Types Of Medicare Advantage Plans

There are two main types of Medicare Advantage plans: Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs). HMOs typically have lower premiums but require you to see doctors and other providers in the plan’s network. PPOs usually have higher premiums but allow you to see out-of-network providers, although you may pay more for doing so.

 

It’s important to note that not all Medicare Advantage plans are the same. Some plans may have higher premiums but lower out-of-pocket costs, while others may have $0 premiums but higher out-of-pocket costs. Some plans have no annual deductible, while others may have a deductible of up to $500.

 

When considering a Medicare Advantage plan, it’s important to compare plans and find one that meets your needs and budget. You can visit the Medicare website or contact a licensed insurance agent.

Drawbacks Of Medicare Advantage

One of the drawbacks of enrolling in a Medicare Advantage plan is that you may have to pay more for your care if you see a doctor or other healthcare provider not in the plan’s network.

 

Another drawback of enrolling in a Medicare Advantage plan is that you may have to pay a deductible, copayments, or coinsurance for some of your care.

 

Finally, if you enroll in a Medicare Advantage plan, you may not be able to get supplemental insurance policies, such as a Medigap policy.

 

If you’re considering a Medicare Advantage plan, it’s important to compare plans and find one that meets your needs and budget. You can do this by visiting the Medicare website or contacting a licensed insurance agent.

Enrolling In A Medicare Advantage Plan

If you’re interested in enrolling in a Medicare Advantage plan, you can do so during the annual open enrollment period, from October 15 to December 31. You can also enroll in a Medicare Advantage plan if you have a life-changing event, such as losing your job-based health insurance coverage or moving out of your plan’s service area.

 

To enroll in a Medicare Advantage plan, you must first be enrolled in both Medicare Part A and Part B. If you’re not already enrolled in Medicare, you can do so by visiting the Social Security website or contacting a licensed insurance agent.

 

Once you’re enrolled in Medicare, you can enroll in a Medicare Advantage plan by visiting the Medicare website or contacting a licensed insurance agent.

Choose The Right Medicare Plan – Choose Nesso Senior Benefits 

If you’re looking for a Medicare Advantage or Original Medicare plan, Nesso Senior Benefits should be your go-to. At Nesso Group, we offer a wide variety of plans with different levels of coverage and deductibles, so you can find one that fits your budget and needs. We also have a network of doctors and other providers so you can get the care you need without having to pay more. 

 

Nesso Group is a holistic people-focused services company located in Connecticut that strives to provide the best possible care for our clients. Nesso Senior Benefits is just one of the many Nesso Group companies committed to providing top-quality health services. We have a team of experts who are available to help you choose the right Nesso Senior Benefits plan for you and your family. 

 

When it comes to choosing a Medicare Advantage plan, we are the clear choice. Contact Nesso Group today to learn more about Nesso Senior Benefits and how we can help you get the coverage you need.

 

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