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Original Medicare vs. Medicare Advantage

If you are considering Medicare coverage for the first time, it can be difficult to know what your options are. There is a lot of information out there – you’ve seen TV commercials, heard radio commercials, and have probably gotten a phone call or two from someone trying to sell you a policy.

One of the first decisions you must make is whether you will keep Original Medicare or enroll in a Medicare Advantage plan.

Your answer depends on your specific needs and preferences.

This article will give you an overview of what each option offers and give you insights on some of the key differences.

What is the Federal Medicare Program?

The Federal Medicare Program is a component of the United States government’s Department of Health and Human Services. It provides healthcare coverage for people who are 65 or older as well as some younger Americans with specific disabilities, as well as those with End Stage Renal Disease.

Original Medicare: Part A and B

Medicare Part A Benefits

The hospital and medical expenses are covered by Part A. It covers in-patient stays, appropriate skilled nursing care given at home or in a healthcare facility, hospice care, and some rehabilitation therapy services provided at home or in a healthcare facility during an acute illness episode that lasts up to 20 days after discharge from the hospital.

If you have met requirements set by the federal government, you will not pay a premium for Medicare Part A. As long as you have worked for ten years, or 40 quarters, you have paid enough Medicare taxes that Part A is now “free” as of your 65th birthday.

Medicare Part B Benefits

Medicare Part B is considered medical insurance. Preventative health services, such as doctor visits and outpatient hospital care, and lab tests are included in Medicare Part B.

A monthly premium applies to Medicare Part B. The standard premium in 2021 is $148.50. Those who have had higher incomes in the recent past may have an increased premium.

Medicare Part B only covers about 80% of medical expenses. It does not offer coverage for most dental, vision, and hearing services, nor do they provide benefits for most prescription drugs.

Senior business woman enjoying her new vision services from her Medicare Advantage Plan?
The advantages, costs, and coverage of your policy will vary depending on the carrier.

What is a Medicare Advantage Plan?

A Medicare Advantage Plan, also known as Medicare Part C, bundles all the coverage offered by Original Medicare plus offers additional health care benefits that are not part of Medicare Parts A and B.

Medicare Advantage plans are offered by private insurance carriers.

The federal government does not regulate Medicare Advantage Plans. This means that each insurance provider can create its own policies, which are unlikely to be identical to those of other insurers.

The advantages, costs, and coverage of your policy will vary depending on the carrier.

Because these plans aren’t standardized, it’s crucial to compare different Medicare Advantage Plans before deciding which one to buy. You may do this by comparing the benefits and out-of-pocket costs of each plan.

Another advantage of Part C plans are that unlike Original Medicare, these plans offer benefits for dental, vision, hearing, and prescription drug coverage. If you opt to join a Medicare Advantage plan, you won’t have to enroll in separate Dental, Vision, and Hearing (DVH) and Part D prescription drug policies.

Finally, Medicare Advantage plans are the only plans that offer Part B Premium Reduction benefits. Not every Part C plan has this benefit, but if it is part of the plan you choose, you could see a reduction in the amount taken from your social security check.

The reduction will vary based on plan and location. It is meant to reduce the Part B monthly premium, which is $148.50 in 2021.

Can I switch between Original Medicare and Medicare Advantage Plans each year?

Yes and no. No medical underwriting is necessary when you first become eligible for Medicare coverage. This implies that you will not be rejected by any insurance firm and that you may choose from any sort of coverage available to you.

However, if you enroll in a Medicare Advantage Plan but later change to another form of insurance, you will be subject to medical underwriting. If you do not pass, insurance firms have the option of denying coverage.

It’s essential to think about future requirements when signing up for Medicare plans.

So, which plan is best for you? Original Medicare? Medicare Advantage? There is no one correct answer.

Give Temmen Insurance a call. We’d be happy to discuss your needs and find the plan that fits your needs. You can also click HERE to submit an information request.