Medicare Advantage (Part C)

Original Medicare (Part A & B) vs. Medicare Advantage (Part C)

Original Medicare only included Parts A & B and is run by the Federal Government. It was designed to cover your basic healthcare needs once you qualify. Medicare Advantage plans are plans that are approved by the Federal government and run by private insurance providers that combine your Part A and B plans as well as Part D (prescription drug coverage).

Original Medicare:

Parts A and B: Part A covers your hospital stays and Part B covers your doctor visits, lab tests, and durable medical equipment like walkers and wheelchairs. You may be responsible for a portion of some of these costs.

Pay as you go: You will receive separate bills for each service you use, similar to an à la carte menu.

Freedom and Flexibility: You can choose any doctor or healthcare provider who accepts Medicare.

Potential Downsides: You may need to purchase a separate Part D plan for prescription drug coverage.  You will not have dental, hearing, or vision coverage. And, your out-of-pocket costs can quickly add up.

Medicare Advantage:

• Private insurance companies bundle Parts A and B, often including Part D into one convenient plan with a set monthly premium or no premium at all. You can choose from HMO or PPO plans. Compare HMO vs. PPO Advantage Plans
• Predictable costs: You know exactly what you’ll pay each month, as well as what each doctor visit will cost if or when you go to the doctor. Many of your preventative visits and procedures are included in your plan at no additional out of pocket cost.
• Extra perks: Many plans offer additional benefits like dental, vision, and even gym memberships. Some plans even help pay for your Part B premiums.
• Potential downsides: Your network of doctors and hospitals could be more limited than Original Medicare, and not every provider accepts Medicare Advantage.
• Part D (Prescription Drug Coverage: Typically included with most plans.

Maximum Out-of-Pocket Limits:

Think of Original Medicare like a bottomless pit. You will always owe 20% of your medical bills each time you visit your doctor or go to the hospital. There is no maximum.

With Medicare Advantage, you have a Maximum Out-of-Pocket (MOOP) that is set each year and that’s the most you can ever pay regardless of how expensive your medical bills truly are. Once you hit that limit, you’re done – your insurance covers everything else for the rest of the year.

Your MOOP is like a safety net, catching you before you fall too far into the pit of unaffordable medical expenses.

Types of Medicare Advantage (Part C) Plans:

• Health Maintenance Organization (HMO)
• Preferred Provider Organization (PPO)
• Special Needs Programs (SNP)
• Medicare Savings Account (MSA)
• Private Fee-for-Service (PFFS)

For details on each of these plans, please contact us or go to Medicare.gov

The Key Takeaway:

Original Medicare gives you ultimate freedom and flexibility, while Medicare Advantage offers convenience and predictability with potentially lower out-of-pocket costs and additional benefits included. Let us help you decide which one is right for you.

Important Note:

Not all hospitals that accept Medicare participate in Medicare Advantage networks. Make sure your preferred providers are in-network before enrolling in a plan.