How are Medicare Advantage plans different from Original Medicare?

Medicare Advantage plans are an alternative option to Original Medicare. Medicare Advantage plan are also known as "Medicare Part C" plans. Medicare Advantage plans are offered by "private insurance companies" and cover all Medicare covered services.

All Medicare Advantage plans are required to offer at least the same benefits and coverage as original Medicare Parts A and B. Most Medicare Advantage plans (but not all) also include Medicare Part D. Depending on the specific Medicare Advantage plan you choose, it may also pay for additional services that aren’t covered by Original Medicare. Many people (but not all) feel the benefit of Medicare Advantage plans is that they offer more coverage than original Medicare. It boils down to personal preference. One type plan doesn’t fit everybody!

Keep in mind: With original Medicare there is not an annual maximum out of pocket expense cap on what you pay out of pocket. However on the other side, Medicare Advantage plans do have an out-of-pocket maximum limit each year! Once you hit a certain dollar amount, your plan pays 100% of the cost for most services it covers. Example: If you had Original Medicare and your covered Medicare medical bills came to $1,000,000.00, you could still be responsible for your 20% coinsurance share of $200,000.00! In that same scenario, if you had a Medicare Advantage plan and your covered Medicare medical bills came to $1,000,000.00, you would only be responsible for your maximum annual out of pocket amount. (Depending on your specific plan, but could be just $6,700.00.)

In most Medicare Advantage plans, (but not all) you can only go to doctors, specialists, and hospitals in the plan’s network. Otherwise, you may pay more if you go out of network. Additionally if you go out of network with some plans (Example: HMO plans) you may not even be covered at all for services, unless it is a true emergency. Although as I mentioned, if you need urgent or emergency care you will be covered, even if you receive care outside the plan’s participating providers. Some examples of Medicare Advantage plans include Health Maintenance Organizations (HMO) or Preferred Provider Organizations (PPO).

Note: Medicare Insurance information can be overwhelming and confusing to many people. As an independent licensed agent I can explain things to you in simple terms so you feel comfortable making a decision. Then I can help you choose and enroll in a plan that you feel fits your needs.

By the way, it doesn’t cost you any more if you enroll in a Medicare Insurance plan through me as an independent agent versus directly with an insurance company either over the phone or via the Internet, since I get paid by the insurance companies for your enrollment. Plus you will have personalized service by a local agent. If you would like my assistance, please call me at 941-404-5334.

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