When you enroll in Medicare Advantage, Medicare pays the insurance company a portion of your Part A and Part B premiums. Under original Medicare, the federal government sets the premiums, deductibles and coinsurance amounts for Part A (hospitalizations) and Part B (physician and outpatient services). In addition, some MA plans offer care not covered by the original option. Part C, or Medicare Advantage, is offered by private insurance companies that covers original medicare (Part A and Part B) services, as well as additional coverage like dental and vision. Medicare plans cost more, as they tend to cover more services. A person can switch from Medicare to a Medicare Advantage plan or vice versa once per year. With so many available options, picking the right Medicare plan might seem overwhelming. This year’s Medicare Annual Enrollment Period is October 15 through December 7. Members save up to 10% on premiums when enrolling online. HMOs tend to have more restrictive choices of medical providers than PPOs. 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. However, the cost of Medicare Advantage plans varies by geographical location. When comparing the Medicare Advantage and Medigap, factor monthly premium and deductible costs. In addition, while MA plans are pretty much available throughout the United States, the choice of plans is more limited in rural areas. There are no Medigap policies for Advantage plans. These parts cover different aspects of medical care and include: If a person or their spouse paid Medicare taxes for 30 quarters of work, they would receive Medicare Part A at a discounted rate when they reach 65 years of age. Last medically reviewed on March 3, 2020. Traditional Medicare and Medicare Advantage have dramatically different costs. If you have decided to keep Medicare Part B, you now need to decide what Medicare plan type is the best for you. Conversely, Medicare Advantage plans generally have lower monthly premiums and may cover more services. Learn how you can switch to a Medigap policy, Medicare Advantage Plan, or Original Medicare. Medicare vs. Medicare Advantage: Ill Health Often Leads to Plan Switch The drawbacks of Medicare Advantage plans can become apparent when serious illness or injury strikes. Medicare Advantage is a one-stop-shopping program that combines Part A and Part B into one plan. These plans are free if a person qualifies. Examples of these conditions may include diabetes, end stage renal disease, HIV, and chronic heart failure. Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional, Medicare Advantage vs. Medicare supplement, Study hints that supplements may reduce COVID-19 risk in females. Medicare Advantage vs Medicare Supplement: exclusions People with end-stage renal disease are generally not eligible for Medicare Advantage plans, except in certain situations. The government also sets maximum deductible rates for the Part D prescription drug program, although premiums and copays vary by plan. Some plans even require a person to pay only the Medicare Part B premium and $0 for prescription drug coverage. For example, under Part B, beneficiaries are responsible for 20 percent of a doctor visit or lab test bill. Other areas of the country may see decreases in plan availability. A person does not usually require a doctor’s referral to see a specialist under these plans, and they typically have a more extensive network of providers to choose from than with an HMO plan. Members save on eye exams and eyewear at participating locations. Medicare Advantage (sometimes called Medicare Part C or MA) is a type of health insurance plan in the United States that provides Medicare benefits through a private-sector health insurer. Understanding Original Medicare vs. Medicare Advantage can help you choose coverage that best fits your health and budget needs. However, in 2020, the average monthly premium was, coinsurance for skilled nursing facilities. They may cost more if a person has an income higher than $88,000 per year. | However, bear in mind that not all doctors who accept Medicare will also accept a private fee-for-service plan. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance. Express Scripts offer three Medicare Part D prescription drug plans. Now there’s anon-going debate as to which option is better. You cannot have both a Medicare Advantage and Medicare Supplement plan. Understanding your health and how you’ll use your plan will help you determine which one may fit your needs. Medicare Advantage is used as an alternative to Original Medicare. A special needs plan is a Medicare plan that supports people with a chronic health condition and other specific needs. Medicare supplement plans can help cover several costs, including: People with concerns about steep out-of-pocket expenses may choose a Medigap plan. But there are significant differences in the way you'll use Medicare depending on whether you pick original or Advantage. again. You can also manage your communication preferences by updating your account at anytime. In other words, you need to compare the Pros and Cons of Medicare Advantage plans vs Original Medicare.. Under original Medicare, to get the full array of services you will likely have to enroll in four separate elements: Part A; Part B; a Part D prescription drug program; and a supplemental or Medigap policy. Hospice benefits come directly from Part A even if you have a Medicare Advantage plan. Under Medicare Advantage, you will essentially be joining a private insurance plan like you probably had through your employer. Medicare Advantage plans can have a maximum out of pocket (MOOP) of up to $6,700 with most plans having a MOOP of about $5,000/year. But instead of paying the 20 percent coinsurance amount for doctor visits and other Part B services, most MA plans have set copay amounts for a physician visit, and typically that means lower out-of-pocket costs than original Medicare. Any doctor and hospital without referrals the cost varies by plan according to Medicare.gov covers your health and you’ll. 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