what is the benefit of a regular medicare plan vs a medicare advantage

Under original Medicare, you can get a wide variety of medical services including hospitalizations; doctor visits; diagnostic tests, such as X-rays and other scans; blood work; and outpatient surgery. Under Medicare Advantage, you will get all the services you are eligible for under original Medicare.

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Is Medicare better than Advantage plans?

6 rows · Dec 01, 2021 · Cost Original Medicare amount; Part A monthly premium: $0, $274, or $499 (depending on how long ...

How much cheaper is Medicare Advantage compared to Medicare?

Sep 16, 2018 · Another significant difference between Original Medicare vs. Medicare Advantage is that with Medicare Advantage, once you reach a specific limit on out-of-pocket expenses, you pay nothing for your covered health care costs. This limit varies from plan to plan and can change each year, so it’s important to check the plan details before you enroll.

Does Medicare Advantage cost less than traditional Medicare?

Most plans offer extra benefits that Original Medicare doesn’t cover – like some routine exams and vision, hearing, and dental services. You can join a separate Medicare drug plan to get Medicare drug coverage (Part D). Medicare drug coverage (Part D) is included in most plans. In most types of Medicare Advantage Plans, you can't join a separate Medicare drug plan.

How does Medicare Advantage compare to Medicare?

These plans have become an integral part of the program - an estimated 42 percent of Medicare recipients are enrolled in a Medicare Advantage (MA) plan, up from 13 percent in 2005. One reason for this growth is all the extra benefits MA plans provide - but which Congress has not yet allowed original Medicare to offer.

What are the disadvantages of a Medicare Advantage plan?

What is the difference between Medicare Advantage and regular Medicare?

What is the benefit of choosing Medicare Advantage rather than the original Medicare plan?

Are there advantages to a Medicare Advantage Plan?

Can you switch back and forth between Medicare and Medicare Advantage?

Does Medicare Advantage cost more than Medicare?

Is Medicare Advantage cheaper than original Medicare?

What is the most popular Medicare Advantage plan?

What are 4 types of Medicare Advantage plans?

Is Medicare Advantage too good to be true?

Does a Medicare Advantage plan replace Medicare?

Can you have Medicare and Medicare Advantage at the same time?

Original Medicare vs. Medicare Advantage: What’S The Difference?

In order to understand the differences between the two programs, it’s important to understand how each one works.Original Medicare, Part A and Part...

Are There Different Types of Medicare Advantage Plans?

Many people like the flexibility that Medicare Advantage plans provide. Unlike Original Medicare, which is the same for everyone, there are several...

How Can I Find Which Medicare Advantage Plans Are Available in My area?

I’m available to help you understand your options. If you prefer, you can request information via email or schedule a phone call at your convenienc...

What is the difference between Medicare and Medicare Advantage?

Medicare Advantage is that the Medicare Advantage program is administered by private insurance companies approved by Medicare to offer benefits. This means that premiums are set by the individual insurance companies and can vary depending on the plan you choose ...

What are the different Medicare Advantage plans?

Some of the popular ones include: Health Maintenance Organizations (HMOs).

How many people are enrolled in Medicare Advantage in 2017?

In 2017, about one-third of all Medicare beneficiaries are enrolled in Medicare Advantage plans according to CMS. If you have Medicare coverage or are approaching Medicare eligibility, you may have questions about which program is right for you.

Does Medicare Advantage cover hospice?

Medicare Advantage plans must offer all the same coverage as Original Medicare (except for hospice care, which is still covered under Part A), but they are able to offer additional benefits to their members.

Does Medicare cover prescription drugs?

Original Medicare generally does not include coverage for prescription drugs, except those medications that must be administered by a medical professional, such as chemotherapy and certain types of injections, for example.

Does Medicare Advantage include Part D?

For example, many Medicare Advantage plans also include Medicare Part D prescription drug coverage, so you get all your Medicare benefits in one convenient plan.

Can you still be in Medicare Advantage?

Remember, if you enroll in a Medicare Advantage plan, you’re still in the Medicare program, which means you have all the same rights and protections as you have under Original Medicare.

Medicare Advantage

You can go to any doctor or hospital that takes Medicare, anywhere in the U.S.

Medicare Advantage

Out-of-pocket costs vary – plans may have different out-of-pocket costs for certain services.

Medicare Advantage

Original Medicare covers most medically necessary services and supplies in hospitals, doctors’ offices, and other health care facilities. Original Medicare doesn’t cover some benefits like eye exams, most dental care, and routine exams.

What is Medicare Advantage?

Medicare Advantage plans have been in existence since 1997, when President Bill Clinton signed the law that created the current system allowing private health care providers to offer a one-stop-shop alternative to Original Medicare. These plans have become an integral part of the program - an estimated 42 percent of Medicare recipients are enrolled in a Medicare Advantage (MA) plan, up from 13 percent in 2005. One reason for this growth is all the extra benefits MA plans provide - but which Congress has not yet allowed original Medicare to offer. For example, many MA plans tout gym benefits plus some dental, vision and hearing care. And in recent years, government officials have given the plans permission to offer transportation to doctor appointments, modifications to beneficiaries' homes such as wheelchair ramps, and even carpet cleaning to help people with respiratory problems. AARP is lobbying Congress to allow original Medicare to offer similar benefits to its enrollees, as is the Center for Medicare Advocacy, which stated in a March report that "there is a growing imbalance between Medicare Advantage and traditional Medicare...relating to the scope of coverage.”

Why do people get Medicare with a Medigap policy?

Alicia Jones, director of the State Health Insurance Assistance Program (SHIP) in Nebraska, says that in her experience, people who have had a history of serious illnesses will more often opt for original Medicare with a Medigap policy because they want predictability when it comes to costs. “They like to know exactly what they are going to be spending,” she says. A Medigap policy “might be a little more expensive, but it does mean you know exactly every month what it’s going to cost.” Roughly 34 percent of original Medicare enrollees buy supplemental Medigap coverage; another 29 percent of enrollees get supplemental coverage through an employer-sponsored retiree benefit.

What is MA plan?

The concept of MA plans is linked closely to the founding idea of Medicare: Provide older Americans with the same kind of health insurance coverage they got when they were working. For the first 20 years of the program, original Medicare did just that by offering plain-style health insurance in which doctors and hospitals simply got paid for services rendered. But as health maintenance organizations (HMOs) and preferred provider organizations (PPOs) came on the scene in a big way during the 1980s and ’90s, more Americans became accustomed to getting care through a single, all-encompassing health care network. That led to the creation in 1997 of Medicare Part C — first called Medicare+Choice and now Medicare Advantage.

What are the downsides of MA plans?

Extra benefits aside, some experts cite a potential downside to the restrictions in MA plans: members’ limited choices for specialist doctors or hospitals. This comes into play particularly when there is a need for a more serious or unique treatment for health issues ranging from cancer to joint replacements; patients in an MA plan often don’t have the option to go to a top-grade but out-of-network research hospital or specialist unless they are willing to pay far more of the costs themselves.

When did MA plans start offering extra benefits?

The extra benefit aspect in MA plans has roots in the 1980s. But the benefits proliferated after 2003, when Congress deemed that if MA plans were able to provide medical care to members for less than what Medicare paid them, the extra money should be put toward either providing extra services or cutting patients’ costs.

Does United Healthcare offer Medicare Advantage?

United Healthcare, the nation’s largest provider of Medicare Advantage plans (many of which carry the AARP brand), says its “Medicare Advantage plans go beyond traditional health care services to try to help address the issues outside the doctor’s office that impact people’s health, such as food security, housing, transportation and social support.” Another example: United and other MA plans have begun offering programs that provide members the ability to have licensed medical staff come to their home.

Can you switch to Medicare if you have a MA plan?

But if you’ve been in an MA plan for longer than a year and choose to switch to original Medicare, in most states Medigap plans can charge you more — or refuse to sell you a policy — if you have a health issue.

What is the maximum out of pocket spending for Medicare?

This was to discourage private insurance from taking advantage of their beneficiaries. For Medicare Advantage plans, those limits are set at $6,700 for in-network services when you are on a Health Maintenance Organization (HMO) plan and $10,000 for in- and out-of-network services combined when you are on a Preferred Provider Organization (PPO) plan. Monthly premiums are excluded from that amount as are any services that would not be covered by Original Medicare. Unfortunately, that means any spending on supplemental benefits does not count towards your cap. Spending on prescription medications, even if they are included in your Medicare Advantage plan, are also considered separately. After you spend the full amount in out of pocket expenses, your Medicare Advantage plan will be responsible for any additional costs over the remainder of the year. Original Medicare does not have an out of pocket spending limit.

How did the government try to decrease expenditures from the Medicare Trust Fund?

In an attempt to decrease expenditures from the Medicare Trust Fund, the government tried to shift the cost of care to the private sector. Insurance companies contract with the government to be in the Medicare Advantage program, and the government pays the plan a monthly stipend for each beneficiary that signs up.

How many people are on Medicare in 2018?

More than 59 million people were on Medicare in 2018. Forty million of those beneficiaries chose Original Medicare for their healthcare needs. 2 . Access to a broader network of providers: Original Medicare has a nationwide network of providers.

When is Medicare open enrollment?

Whether you are new to Medicare or are looking to change your plan during the Medicare Open Enrollment Period (October 15 - December 7) , you have an important decision to make. Is Original Medicare or Medicare Advantage the right choice for you? To understand your choices, you need to understand how they differ.

Does Medicare Supplement cover medical bills?

That's where a Medicare Supplement plan, also known as a Medigap plan, can come into play. These supplement plans do not cover health care directly but help to pay off any costs Original Medicare leaves on the table, i.e., deductibles, coinsurance, copays, and even emergency care in a foreign country.

Does Medicare Advantage have a restricted network?

Best of all, that network is not restricted based on where you live like it is with Medicare Advantage. All you need to do is pick a doctor that takes Medicare. If you find a doctor that accepts assignment too, meaning they also agree to the Medicare Fee Schedule that is released every year, even better.

Can you change your Medicare plan during open enrollment?

If you find that the plan you have chosen does not work in your favor, you can always make a change during Medicare Open Enrollment the following year.

What is the difference between Medicare Advantage and Original?

Another key difference between Original Medicare and Medicare Advantage plans is that Medicare Advantage plans are able to offer additional benefits not available ...

What are the rights of Medicare Advantage?

First of all, even if you choose a Medicare Advantage plan, you are still enrolled in the Medicare program and covered by all its rights and protections, such as: 1 The right to be treated with respect and dignity and protected against discrimination 2 The right to appeal any decisions made by your plan 3 The right to file a grievance or complaint about the care you received from a health-care provider or facility

Can you be sold Medicare Supplement?

In fact, it’s illegal for you to be sold a Medicare Supplement insurance plan if you are enrolled in Medicare Advantage.

Does Medicare have an annual cap?

Once you reach this limit, you generally pay nothing for covered services for the rest of the year. This annual limit may vary by plan and it can change from year to year, but you always have the guarantee that your health expenses can never exceed the annual limit.

Does Medicare Advantage cover hospice?

Federal law requires that all Medicare Advantage plans offer the same coverage, at a minimum, as Original Medicare (except for hospice care, which is still covered by Part A), and these plans are available through private insurance companies approved by Medicare.

What is Medicare Advantage?

Under Medicare Advantage, you will essentially be joining a private insurance plan like you probably had through your employer. The most common ones are health maintenance organizations (HMOs) and preferred provider organizations (PPOs). Medicare Advantage employs managed care plans and, in most cases, you would have a primary care physician who would direct your care, meaning you would need a referral to a specialist. HMOs tend to have more restrictive choices of medical providers than PPOs.

What percentage of doctors accept Medicare?

According to the Kaiser Family Foundation, 93 percent of primary physicians participate in Medicare. That means chances are pretty good that any doctor you are currently seeing will accept Medicare and you won't have to change providers.

What is Medicare buffet?

If you elect to go with original Medicare, your buffet will include Part A (hospital care), Part B (doctor visits, lab tests and other outpatient services) and Part D (prescription drugs). If you decide to go with Part C, a Medicare Advantage plan, it will be more like a set menu, since a private insurer has already bundled together parts A and B and almost always D into one comprehensive plan.

Does Medicare have an annual cap?

Many beneficiaries who elect original Medicare also purchase a supplemental – or Medigap – policy to help defray many out-of-pocket costs, which Medicare officials estimate could run in the thousands of dollars each year. There is no annual cap on out-of-pocket costs.

Does Medicare cover dental?

While Medicare will cover most of your medical needs, there are some things the program typically doesn't pay for -— like cosmetic surgery or routine dental, vision and hearing care. But there are also differences between what services you get help paying for.

Is Medicare Advantage based on out-of-network providers?

Medicare Advantage plans are based around networks of providers that are usually self-contained in a specific geographic area. So, if you travel a lot or have a vacation home where you spend a lot of time, your care may not be covered if you go to out-of- network providers, or you would have to pay more for care.

Is Medicare Advantage a one stop shop?

Medicare Advantage is a one-stop-shopping program that combines Part A and Part B into one plan. In addition, about 90 percent of MA plans also include prescription drugs, which means you wouldn't have to enroll in a separate Part D plan. There are no Medigap policies for Advantage plans.

What is Medicare Advantage?

To start, Medicare Advantage provides a fixed set of options for you whereas Medicare provides you with a “buffet” style choice of options. For example, a 65-year-old has options regarding their health insurance plan/benefits. Options include traditional Medicare, which is federally run, or Medicare Advantage, which is handled through private insurance. Traditional Medicare includes Part A (hospital), Part B (outpatient) and a separate entity Part D (prescription drugs). Medicare Advantage is also known as Part C which includes Part A, B, and almost always D, with extra benefits such as dental, vision, hearing, and sometimes even gym memberships combined into one comprehensive plan.

How does a patient pick which plan they want to have?

How does a patient pick which plan they want to have? A patient needs to go through the advantages and disadvantages of each plan and pick the plan most suitable for them . If a patient travels a lot within the United States, maybe traditional Medicare would be a better choice regarding provider flexibility. If a patient prefers having the extra services such as dental, hearing, and vision, maybe Medicare Advantage would be better. Each patient must reason with which plan they choose.

What are the benefits of Medicare Advantage?

3 The plans also can provide benefits not covered by traditional Medicare, such as eyeglasses, fitness benefits, and hearing aids. Medicare Advantage plans are intended to manage and coordinate beneficiaries’ care. Some Medicare Advantage plans specialize in care for people with diabetes and other common chronic conditions, including Special Needs Plans (SNPs); SNPs also focus on people who are eligible for both Medicare and Medicaid and those who require an institutional level of care.

Why is Medicare Advantage important?

Paying Medicare Advantage plans appropriately and fairly is important not only to their enrollees but also to beneficiaries in traditional Medicare, since higher payments to plans raise Part B premiums for all beneficiaries and erode the solvency of the Medicare Hospital Insurance Trust Fund. 13 With Medicare Advantage enrollment projected to overtake traditional Medicare enrollment over the next decade, maintaining sufficient coverage choices and facilitating innovation — while also ensuring that Medicare Advantage plans provide efficient, effective, and equitable care — will remain a challenging balancing act.

What is the racial distribution of Medicare beneficiaries?

Racial/ethnic distribution of enrollees. The racial and ethnic distribution of beneficiaries in traditional Medicare and Medicare Advantage is similar, after separating SNPs from other Medicare Advantage plans (Exhibit 2). Most beneficiaries in traditional Medicare and Medicare Advantage plans identify as white. However, SNP enrollees are significantly more likely to identify as Hispanic or Black.

Why is it important to separate SNPs from other Medicare Advantage plans?

Analyses by the Medicare Payment Advisory Commission (MedPAC) have shown that, on average, these plans have lower medical loss ratios (suggesting higher profits) than other types of Medicare Advantage plans. 10 This indicates that insurers’ interest in serving these populations will likely continue to grow. The findings also raises the imperative to examine these plans separately from other Medicare Advantage plans in order to ensure high-quality, equitable care.

How long does it take to get a doctor appointment with Medicare?

Wait times. Wait times for hospital outpatient and physician office visits are similarly long for traditional Medicare and Medicare Advantage, averaging about three weeks for a hospital outpatient visit and over one month for a physician office appointment (data not shown). Waits were similar among those with mental health conditions and other common conditions.

Do SNPs have lower incomes?

Beneficiaries in SNPs are different. Given the eligibility criteria for these plans, it is not surprising that enrollees tend to have significantly lower incomes and a greater likelihood of receiving Medicaid benefits or LIS than other Medicare beneficiaries. Enrollment in SNPs for people who require an institutional level of care has been growing rapidly, leading to a similar share of SNP enrollees and beneficiaries in traditional Medicare living in a long-term-care facility. 8

Is Medicare Advantage increasing?

Issue: Enrollment in Medicare Advantage plans continues to increase rapidly. This has led to questions about which beneficiaries are enrolling in Medicare Advantage or in traditional Medicare and how their health care experiences compare.

What is Medicare Advantage Plan?

Individuals who have traditional Medicare, or a Medicare Advantage plan that does not include prescription drug coverage, who want Part D coverage, must purchase it separately. This is called a “stand-alone” Prescription Drug Plan (PDP). A Medicare Advantage plan that includes both health and drug coverage is referred to as a Medicare Advantage ...

What is a Medigap plan?

Medigap plans (also known as Medicare Supplement Insurance), are private health insurance plans that help pay for the "gaps" in payment for Medicare-covered care left by traditional Medicare ; these include copayments, coinsurance, and deductibles. In many cases, someone with traditional Medicare must purchase a separate Part D drug plan as well as a Medigap plan to supplement their Medicare benefits. Medigap policies do not work with MA plans and it is illegal for anyone to sell an MA enrollee a Medigap policy unless they are switching to traditional Medicare.

How to contact Medicare in MA?

Individuals can obtain help and a list of MA plans in their area from their State Health Insurance Assistance Program (SHIP), the Medicare helpline (1-800-633-4227) , or the Medicare website ( www.Medicare.gov ).

Does Medicare have a cap on out-of-pocket expenses?

You may also have to pay for deductibles, coinsurance and copays. Traditional Medicare has no out-of-pocket maximum or cap on what you may spend on health care. With traditional Medicare, you will have to purchase Part D drug coverage and a Medigap plan separately (if you choose to purchase one). Medicare Advantage.

Can you appeal a Medicare decision?

Regardless of how you receive your Medicare benefits you always have the right to appeal unfavorable decisions regarding coverage of your services. However, timeframes and deadlines differ depending on whether you have traditional Medicare or a Medicare Advantage plan.

Do you need to buy a Medigap plan?

Some beneficiaries have employer or union coverage that pays costs that traditional Medicare does not cover; those who do not may need to buy a Medigap plan. Other individuals may be eligible for Medicaid that can also cover such costs and may not need Medigap.

Does Medicare Advantage cover urgent care?

If you are enrolled in a Medicare Advantage plan you may be limited by the MA plan to using a network of specific providers in order for the plan to cover your care. You may have to choose a primary care physician, obtain referrals to see specialists, and get prior authorization for certain services. Certain MA plans may cover care you get outside of the network, but you will likely have to pay more. Most plans may only cover emergency and urgent care if you are out of the service area; you must return to the service area for follow up or routine care. Network providers can join or leave a plan’s provider network anytime during the year but, generally, you must wait until the next year’s open enrollment period to opt to leave the plan. The MA plan can also change the providers in the network anytime during the year.