If you are approaching age 65, you may be starting to think about the government benefits you will soon qualify for. For example, your healthcare option to elect between Original Medicare or a Medicare Advantage plan. What’s the difference?
Original Medicare comes in two parts: Part A and Part B. Part A covers a portion of hospitalization expenses, and Part B applies to doctor visits and medical expenses, such as lab tests and some preventative screenings.
A Medicare Advantage plan, also known as Part C, is an “all-in-one” alternative to Original Medicare. These “bundled” plans include the benefits of Part A, Part B and Part D (prescription drugs). Some people choose a Medicare Advantage Plans over Original Medicare because these plans offer coverage like vision, hearing, dental and more.
Saves You Money
First and foremost, Medicare Advantage Plans save Medicare members money –and not just a little bit of money, but a lot of money.
Original Medicare only pays 80% of the cost of medical care – the Medicare beneficiary is responsible for the other 20%. A Medicare Advantage Plan is different. The Medicare Beneficiary is only responsible for a small copay, typically less than 20% of a doctor visit or procedure.
More importantly, Medicare Advantage Plans have a maximum out-of-pocket amount, meaning that once you reach the limit, the Plan pays 100% of all medical services. That alone can save thousands of dollars per year – particularly if there is a hospitalization involved.
Dental, Vision and Hearing Coverage
What sets Medicare Advantage plans apart is the additional benefits provided that Original Medicare doesn’t cover.
These benefits include dental coverage, vision coverage, hearing exams and hearing aid coverage. None of these important health care benefits are included in Original Medicare. Also, most Medicare Advantage Plans include prescription drug coverage at no additional cost, while individuals with Original Medicare need to sign-up and pay extra for Part D prescription drug coverage.
Medicare Advantage Plans offer more benefits than Original Medicare and they help members save on their health care costs.
Focus on Accessibility, Wellness and Preventative Health
Accessible healthcare coverage is key to staying on top of your health. To join a Medicare Advantage Plan you must have Part A and Part B coverage and live in the plan’s service area. It is important to remember that Original Medicare is only valid in the United States. Fortunately, many Medicare Advantage Plans offer worldwide emergency coverage.
Another important healthcare consideration to keep in mind is Medicare Advantage Plans focus on your overall well-being. They offer preventative and wellness-related benefits at no cost to you. This includes important benefits like free over-the-counter medicines and free gym memberships. You won’t find those types of benefits with Original Medicare.
Medicare Supplement Plans (Medigap)
Some people confuse a Medicare Supplement Plan, also known as a Medigap Plan, with Medicare Advantage Plans. They are different and the biggest difference is Medicare Supplement plans come with ever-increasing premiums because they are based on your age. This means the cost of these plans increase every year. Plus, they don’t offer any supplemental benefit coverage like vision, dental or hearing.
That’s not the case with a Medicare Advantage Plan. In many cases, there is no monthly premium and you receive all manner of supplemental benefits. These benefit-rich, zero-dollar premium Medicare Advantage plans are enticing people to say goodbye to pricy Medicare supplement plans and hello to Medicare Advantage Plans.
Don’t worry, if you join a Medicare Advantage Plan for the first time and you aren’t happy with the plan, you’ll have special rights under federal law to buy a Medigap policy and a Medicare drug plan if you return to Original Medicare within 12 months of joining the Medicare Advantage Plan.
The Flexibility to Change Your Mind
A common misconception about Medicare Advantage Plans is that when you join, you are still on Medicare and are not giving up your Medicare coverage. Medicare Advantage Plans are considered “Medicare Part C.” This means they combine your Medicare Part A (hospital coverage), Part B (doctor’s coverage) and Part D (prescription drug coverage) into one convenient package that costs less and provides more.
You can only join, switch or drop a Medicare Advantage Plan during the enrollment periods:
Initial Enrollment Period: When you first become eligible for Medicare, you can sign up during your Initial Enrollment Period. For many, this is the seven-month period that begins three months before the month you turn 65, includes the month you turn 65, and ends three months after the month you turn 65.
General Enrollment Period: If you have Part A coverage and you get Part B for the first time during this period (between January 1 - March 31 each year), you can also join a Medicare Advantage Plan. Your coverage may not start until July 1.
Annual Election Period: Between October 15 and December 7, anyone with Medicare can join, switch or drop a Medicare Advantage Plan. Your coverage will begin on January 1 (as long as the plan receives your request by December 7).
Medicare Advantage Plans have been around for more than 25 years and continue to grow in popularity. In some parts of the country, more than half of all Medicare beneficiaries are enrolled in a Medicare Advantage Plan. Only 40% are enrolled here in Nevada, but that number is growing every year.
Hear from Chris Gourlay, RHU, ChHC, and Enrollment Specialist at Senior Care Plus as he explains all the benefits that Senior Care Plus products offer for 2023.