Medicare Blog

what the difference between medicare plans vs medicare advantage plans

by Iliana Robel Published 3 years ago Updated 2 years ago
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Medicare Advantage costs

Cost Medicare Advantage amount
Part B monthly premium $170.10
Medicare Advantage plan monthly premium varies (can start at $0)
Medicare Advantage plan deductible varies (can start at $0)
Medicare Advantage plan drug deductible varies (can start at $0)
Jul 14 2022

Original Medicare covers inpatient hospital and skilled nursing services – Part A - and doctor visits, outpatient services and some preventative care – Part B. Medicare Advantage plans cover all the above (Part A and Part B), and most plans also cover prescription drugs (Part D).

Full Answer

How much cheaper is Medicare Advantage compared to Medicare?

Medicare Advantage (also known as “MA”) plans monthly premiums are typically much lower than a traditional Medicare Supplement plan. The reasoning behind this is “cost sharing.” Some Medicare Supplements cover 100% of the cost sharing left by Medicare on Medicare approved expenses.

How does Medicare Advantage compare to Medicare?

Typically, studies have shown that Medicare Advantage plans cost no more than Original Medicare plans and still offer more freebies and extra services because private companies provide them.

How do I choose the best Medicare Advantage plan?

  • Do your important physicians participate in any Medicare Advantage plans or do they only accept Original Medicare?
  • What insurance is accepted by your preferred hospitals?
  • Do you travel out of the area frequently? ...
  • What is your risk tolerance? ...
  • How about peace of mind? ...

What are the best Medicare Advantage plans?

What to Know About the Best Medicare Advantage Plans

  • Most Medicare Advantage plans are PPO and HMO. Most Medicare Advantage plans are either PPO or HMO, representing 46% and 39% of available plans. ...
  • Most Medicare Advantage plans include prescription drug coverage. ...
  • Vision, dental and hearing benefits are widespread. ...
  • Just over half of Medicare Advantage plans have $0 premiums. ...

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What is the biggest disadvantage of Medicare Advantage?

Medicare Advantage can become expensive if you're sick, due to uncovered copays. Additionally, a plan may offer only a limited network of doctors, which can interfere with a patient's choice. It's not easy to change to another plan. If you decide to switch to a Medigap policy, there often are lifetime penalties.

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

Under Medicare Advantage, you will get all the services you are eligible for under original Medicare. In addition, some MA plans offer care not covered by the original option. These include some dental, vision and hearing care. Some MA plans also provide coverage for gym memberships.

Is Medicare Advantage cheaper than original Medicare?

The costs of providing benefits to enrollees in private Medicare Advantage (MA) plans are slightly less, on average, than what traditional Medicare spends per beneficiary in the same county. However, MA plans that are able to keep their costs comparatively low are concentrated in a fairly small number of U.S. counties.

Why would someone choose a Medicare Advantage plan?

Medicare Advantage plans can serve as your “one-stop” center for all your health and prescription drug coverage needs. Most Medicare Advantage plans combine medical and Part D prescription drug coverage. Many also coordinate the delivery of added benefits, such as vision, dental, and hearing care.

What percent of seniors choose Medicare Advantage?

A team of economists who analyzed Medicare Advantage plan selections found that only about 10 percent of seniors chose the optimal Medicare Advantage plan. People were overspending by more than $1,000 per year on average, and more than 10 percent of people were overspending by more than $2,000 per year!

Why do I need Medicare Part C?

Medicare Part C provides more coverage for everyday healthcare including prescription drug coverage with some plans when combined with Part D. A Medicare Advantage prescription drug (MAPD) plan is when a Part C and Part D plan are combined. Medicare Part D only covers prescription drugs.

Can you switch back to Medicare from Medicare Advantage?

Yes, you can elect to switch to traditional Medicare from your Medicare Advantage plan during the Medicare Open Enrollment period, which runs from October 15 to December 7 each year. Your coverage under traditional Medicare will begin January 1 of the following year.

What will Medicare not pay for?

Generally, Original Medicare does not cover dental work and routine vision or hearing care. Original Medicare won't pay for routine dental care, visits, cleanings, fillings dentures or most tooth extractions. The same holds true for routine vision checks. Eyeglasses and contact lenses aren't generally covered.

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

If you join a Medicare Advantage Plan, you'll still have Medicare but you'll get most of your Part A and Part B coverage from your Medicare Advantage Plan, not Original Medicare. You must use the card from your Medicare Advantage Plan to get your Medicare- covered services.

What is the most popular Medicare Advantage plan?

AARP/UnitedHealthcare is the most popular Medicare Advantage provider with many enrollees valuing its combination of good ratings, affordable premiums and add-on benefits. For many people, AARP/UnitedHealthcare Medicare Advantage plans fall into the sweet spot for having good benefits at an affordable price.

What is the out-of-pocket maximum for Medicare Advantage plans?

The US government sets the standard Medicare Advantage maximum out-of-pocket limit every year. In 2019, this amount is $6,700, which is a common MOOP limit. However, you should note that some insurance companies use lower MOOP limits, while some plans may have higher limits.

What are the 4 types of Medicare?

There are four parts of Medicare: Part A, Part B, Part C, and Part D.Part A provides inpatient/hospital coverage.Part B provides outpatient/medical coverage.Part C offers an alternate way to receive your Medicare benefits (see below for more information).Part D provides prescription drug coverage.

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.

Understanding Each Plan

Knowing the basics of Original Medicare vs. Medicare Advantage plans is crucial before learning the nuances of their differences

Original Medicare Eligibility

Original Medicare is a health insurance plan provided by the federal government to those 65 years and older, younger people with disabilities, and those with End-Stage Renal Disease (ESRD). Standard Medicare plans come with Part A (hospital insurance) and Part B (medical insurance).

Original Medicare Enrollment Periods

There are three enrollment options when it comes to a standard Medicare plan, and they are known as initial enrollment, general enrollment, and special enrollment.

Medicare Advantage Eligibility

Those who are eligible or are already receiving coverage through Original Medicare are also available to enroll in a Medicare Advantage (MA) plan. These plans are also known as Medicare Part C or MA plans, and they are provided through private insurance companies that the federal government partially funds.

Medicare Advantage Enrollment Periods

nrollment periods for Medicare Advantage plans are similar to those for Original Medicare. The MA enrollment periods include initial enrollment, general enrollment, and fall open enrollment.

Understanding Coverage

When it comes to coverage, Original Medicare and Medicare Advantage provide different options. Medicare as a whole is broken down into three main parts: Part A (hospital coverage), Part B (medical coverage), and Part D (prescription drug coverage). Original Medicare provides coverage through Parts A and B with an option to add Part D.

Understanding Cost

When it comes to cost, Original Medicare and Medicare Advantage plans differ because they are provided through different mediums. Original Medicare is provided and covered by the federal government; meanwhile, Medicare Advantage plans are issued by private insurance companies.

Why is Medicare cost plan convenient?

It’s one of the main reasons why Medicare Cost plans are convenient for those who travel during their retirement. Depending on the type of Medicare Advantage plan, consumers must see providers in-network and either pay out-of-pocket or a higher premium if they happen to be traveling outside of their coverage area.

What is Medicare Part C?

Medicare Part C refers to Medicare Advantage plans offered by private insurance companies, and Medicare Part D offers prescription drug coverage. [Read: Medicare Open Enrollment: What You Need to Know .] In some parts of the country, beneficiaries have the option to enroll in Medicare Cost plans offered by private insurance companies. ...

Which state has the highest Medicare enrollment?

Overall, Minnesota has the nation’s largest concentration of people with Medicare Cost plans, according to KFF: 380,195 in 2017.

Is Medicare a hybrid plan?

According to Gerald Kominski, director of the Center for Health Policy Research at the University of California–Los Angeles, Medicare Cost plans are a “hybrid” between health maintenance organizations, or HMOs, which restrict enrollees to a network of providers, and preferred provider organizations, or PPOs, that have a broader network of providers.

Does Medicare cost plan work?

Medicare Cost plans pay based on the reasonable cost of delivering services , while Medicare Advantage plans accept the financial risks if costs exceed fixed payments per enrollee. With Medicare Cost plans, Original Medicare steps in only when the enrollee goes out-of-network for care, not when costs are exceeded.

Is Medicare the best option for older adults?

Depending on where you live, Medicare Cost plans may offer the “best of both worlds” for older adults who want the flexibility of keeping their traditional Medicare benefits while simultaneously having access to out-of-network health care providers.

Does Medicare cover out of network expenses?

If you have a Medicare Cost plan, Original Medicare will help cover expenses incurred out-of-network.

What is the difference between Medicare Supplement and Medicare Advantage plans?

Both Medicare Supplement Insurance and Medicare Advantage plans are private Medicare options sold through individual insurance companies.

What is Medicare Advantage?

Medicare Advantage plans are a type of private Medicare insurance that offers all of the same benefits as Original Medicare.

Why should I enroll in a Medicare Supplement Insurance plan?

When you use Medicare Part A or Part B benefits , you’ll often be left with some out-of-pocket expenses like deductibles, coinsurance or copayments. This is known as “cost sharing.”

How do Medicare Advantage plans work?

Here are a few examples of how a Medicare Advantage plan can work (remember that benefits and network restrictions can vary from plan to plan):

How do I choose between Medicare Supplement Insurance and a Medicare Advantage plan?

In 2021, over 24 million Medicare beneficiaries are enrolled in a Medicare Advantage plan. 1

How does a Medigap plan work?

Here are a few examples of how a Medigap plan can work: You schedule a doctor’s appointment with a doctor for services that are covered by Medicare Part B. The doctor accepts Medicare “assignment” — this means she accepts Medicare’s reimbursement rate for all covered services as payment in full.

What is the deductible for Medicare 2021?

1 Plans F and G offer high-deductible plans that each have an annual deductible of $2,370 in 2021. Once the annual deductible is met, the plan pays 100% of covered services for the rest of the year. The high-deductible Plan F is not available to new beneficiaries who became eligible for Medicare on or after January 1, 2020.

What are the benefits to Medicare Advantage?

Medicare Advantage covers more than Medicare (Part A and Part B), allowing patients more options and flexibility. Patients can customize their Medicare Advantage to cover specific needs like wheelchair ramps, adult day care, and respite care. Additionally, the 2020 CARES Act expanded Medicare's network to cover more telehealth services. 7

How many Medicare Advantage plans will be available in 2021?

Additionally, as there were more than 4,800 Medicare Advantage plans offered for 2021, it's important to take the time to find the best plan for your unique circumstances. 7

Why do I need Medigap if I already have Medicare?

Since Medicare only covers about 80% of medical costs, 3 signing up for Medigap can give you fuller coverage and peace of mind. Medigap is a private insurance option that is designed to work well with Medicare (Part A and Part B) plans.

What is a Medigap policy?

Medigap policies are private plans, available from insurance companies or through brokers, but not on medicare.gov . They are labeled Plans A, B, C, D, F, G, K, L, M, and N, each with a different standardized coverage set. Plans F and G also offer high-deductible versions in some states. 12 Some plans include emergency medical benefits during foreign travel. Since coverage is standard, there are no ratings of Medigap policies. Consumers can confidently compare insurer’s prices for each letter plan and simply choose the better deal.

How long can you stay on medicare?

You generally won't have to pay a penalty if you later decide to enroll in a Medicare prescription drug plan and you haven't gone for longer than 63 continuous days without creditable coverage. 98.

What happens if you don't enroll in Medicare?

Once you’ve enrolled in Medicare, a key decision point is choosing coverage for Part D prescription drug insurance . If you don’t enroll in Part D insurance when you start Medicare and want to buy drug coverage later on, you may be permanently penalized for signing up late. 8

How to get started with Medicare?

To get started, find the plans available in your zip code. Once you have created an account at Medicare.gov, you can enter the names of your drugs and use a convenient tool that allows you to compare plan premiums, deductibles, and Medicare star ratings. 10 

What is the difference between Medicare Advantage and Original?

With Original Medicare you can go to any hospital and see any doctor or provider within the U.S. who accept Medicare. You do have limited coverage in foreign countries, though.

Why would you pay more with Medicare Advantage or Original?

You could have higher monthly premium payments with Original Medicare than with Medicare Advantage, because you might want to add a Part D prescription drug plan or other additional coverage. You may pay more copays with Medicare Advantage than with Original Medicare.

What is Medicare Made Clear?

Medicare Made Clear is brought to you by UnitedHealthcare to help make understanding Medicare easier. Click here to take advantage of more helpful tools and resources from Medicare Made Clear including downloadable worksheets and guides.

Why would Medicare premiums be higher with Original Medicare?

You could have higher monthly premium payments with Original Medicare than with Medicare Advantage, because you might want to add a Part D prescription drug plan and/or a Medicare supplement plan. Consider how often you leave home.

What is a low cost Medicare plan?

A low-cost or $0 plan premium. A plan deductible (not all Medicare Advantage plans have one) Copays for covered health services and items. A note about financial protection: A really great benefit with a Medicare Advantage plan though is there is a limit on your out-of-pocket costs (deductibles, coinsurance and copays).

What are the costs of Medicare Advantage?

Costs with Medicare Advantage vary but may include: 1 The Part B premium 2 A low-cost or $0 plan premium 3 A plan deductible (not all Medicare Advantage plans have one) 4 Copays for covered health services and items

Why do you need to see providers in Medicare Advantage?

With most Medicare Advantage plans, you need to see providers who are in the plan network in order to avoid added costs. Network providers agree to the plan’s negotiated prices so you get to take advantage of the cost savings. If you travel a lot, consider how your Medicare coverage may work with this.

What plan is more affordable?

Medicare Advantage plans will have lower out-of-pocket expenses because they manage the resources that you use. The cost of prescription drugs is usually included in the plan. Some plans offer other benefits too —such as vision, dental, and fitness programs. What you give up is the ability to see out-of-network providers at the same low cost.

What is Medicare Part C?

Here is another easy one. Medicare Part C and Medicare Advantage are the same thing. This article will use “Medicare Advantage”. So far, so good.

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