Now is the time to review Medicare Advantage

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If you want to enroll in Medicare Advantage for the first time, or you are already in the program but want to change plans, this is the time. You have until January 31st, when the open enrollment period ends.

You can also, if you consider it appropriate, to return to Original Medicare during this period.

Most Medicare beneficiaries change their plans because their doctors are no longer in that plan, or because they no longer cover the drugs they need.

If in doubt, and to help you decide, the following are some comparisons between Original Medicare and Medicare Advantage in terms of general features, coverage, and costs.

In an overview, the main features of both plans are:

Original Medicare

  • Includes Part A (hospital insurance) and Part B (health insurance).
  • If you want drug coverage, you can have a separate Part D plan.
  • To help with out-of-pocket expenses (such as 20% of coinsurance), you can also buy a Supplemental coverage (for example Medigap).
  • You can go to any doctor or hospital that accept Medicare, anywhere in the United States.
  • In most cases, you don’t need an order from your primary care physician to see a specialist.

Medicare Advantage

  • Offers a “single window” with bundled plans that include Part A and Part B, and generally Part D.
  • These plans may have lower out-of-pocket costs than Original Medicare.
  • In most cases, you will need to use doctors that are in the plan’s network.
  • Most plans offer extra benefits that Original Medicare doesn’t cover, like, vision, hearing, dentistry and more.
  • You may need a warrant to see a specialist.

The ability to see any doctor participating in the program or go to any hospital is for many an advantage of Original Medicare over Medicare Advantage.

Especially with the rise in age-related medical conditions.

Another important comparison to make is that of the costs of both plans.

Original Medicare costs

  • For Part B of services, you will usually have to pay 20%, until you reach your deductible.
  • You pay a premium for Part B, and another for Part D, if you choose, to have drug coverage.
  • There is no annual limit on what you pay out of your pocket unless you have coverage (like a Medigap policy).
  • You can get supplemental coverage (like a Medigap policy) to help pay remaining out-of-pocket costs (like your 20% coinsurance). Or you can use the coverage of a former employer or union, or Medicaid.

Medicare Advantage costs

  • Out-of-pocket costs vary and can sometimes be lower than Original Medicare.
  • You can pay a premium for the plan in addition to a monthly premium for Part B. (Most include prescription drug coverage). Plans can have $ 0 premium or can help pay all or part of Part B premiums.
  • Plans have an annual limit on what you pay out of pocket for Medicare Part A and B covered services. Once you reach your plan limit, you won’t pay nothing for services covered by Part A and Part B under the The rest of the year.
  • You cannot buy or use supplemental coverage.

Finally, the essential differences in coverage

Original Medicare coverage

  • Original Medicare covers most services and supplies needed in hospitals, doctor’s offices and other health care spaces.
  • You can buy a separate Part D plan to cover your drugs.
  • In most cases, you don’t need to get pre-approved for a service or supply to be covered.

Medicare Advantage coverage

  • Plans must cover all medically necessary services what Original Medicare covers. Most plans can offer extra benefits that Original Medicare doesn’t cover, like vision, hearing, dentist and others. Plans can now cover more of these benefits than in the past.
  • Drug coverage is included in most plans.
  • In some cases, you must get a service or supply approved in advance to be covered by the plan.

Sources: medicare.gov, CMS.

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