It’s no secret that health insurance is one of, if not the most talked about topic in the United States. Americans value their health so much that the subject of health insurance tends to decide who to vote for. This goes to show you how important it is to us as a people.
Still, with all the discussion surrounding it, health care remains quite expensive in the United States. Many individuals are just one sickness away from running out of cash. As a result, the federal government has initiated a program to help many Americans pay their medical bills without breaking a sweat.
Original Medicare is a national program that subsidizes health care costs for Americans aged 65 or older, younger Americans with disabilities, and people with end-stage renal diseases. About two-thirds of eligible Americans are enrolled in the government-sponsored program.
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However, other private insurers sell health care insurance plans, known as Medicare Advantage Part C (or D).
Both government and private insurers offer great plans, but which of these two is right for you?
Original Medicare Vs. Medicare Advantage Part C
A series of questions tend to pop when you’re getting ready to sign up for a Medicare plan for the first time. What plans should I choose? Original Medicare or Medicare Advantage? Do I need Medicare Supplement Insurance? Should I switch to another plan?
These are legitimate questions, so you don’t have to beat yourself for being too curious. Many of us ask these same questions every time. It’s, therefore, important to understand some of the factors that can help you make an informed decision on the right coverage for you. These considerations include:
- Cost
It’s no surprise that we have this at the top of our consideration checklist. The reason for buying a health insurance plan, in the first place, is because of medical costs. Therefore, the average American needs to know how much they will be spending on premiums and other deductibles.
Do they get to pay out-of-pocket for hospital services like doctor visits? If so, is there a limit to how much they could pay out-of-pocket? These questions aren’t too much to ask before purchasing a Medicare plan. It’ll be wrong not to understand these conditions before enrolling in a Medicare plan adequately.
When choosing between Original Medicare (Part A and B) vs. Medicare Advantage (Part C), the latter seems more cost-effective. With Original Medicare, there are no yearly limits to out-of-pocket payments unless you purchase supplemental coverages. If you enroll for a Medicare Advantage plan, you’ll pay zero dollars in covered services for the rest of the year, provided that you’ve reached a specific limit of out-of-pocket payment.
- Coverage
It’s important to know the services your Medicare plan covers. An Original Medicare plan consists of Part A and Part B. A Part A plan covers medical services like hospitalization and home health care. Part B generally covers health care services like preventive services and physician services.
Medicare Advantage (Part C) plans cover all the services that an Original Medicare plan covers. In fact, some plans offer additional benefits like vision, hearing, or dental care.
But you shouldn’t be in haste to make changes, especially if you have other types of coverage, like prescription drug or employment-related coverage. Some health coverage works with Medicare, so it’s good you understand how they work together. You can speak with your insurer before opting out or making any changes.
How about supplemental coverage? In Original Medicare, you can add a Medigap policy covering out-of-pocket expenses, like deductibles and coinsurance.
Medicare Advantage gives you the luxury of lower-cost sharing. However, you can’t purchase a Medigap policy if you enroll in a Medicare Advantage plan.
If you need help, Assurance finds both Medicare Advantage & Medigap plans with ease.
- Reviews and Overall Satisfaction
There are different health care plans with varying offers and quality of service. If you’re already enrolled in a Medicare plan, you should ask yourself these questions: are you satisfied with the medical care you’ve received or are receiving? What are the reviews from other enrollees? Are they positive?
- Drug Prescriptions
Not all Medicare plans cover drug prescriptions, and many people get frustrated when they discover this. It’s good to know whether or not you need to join a Medicare Prescription Plan and how much it costs. Also, you may need to be sure whether or not you’re eligible for a free Medication Therapy Management program. If not, how much will you be paying for it?
Original Medicare doesn’t include drug coverage under its plan’s formulary. As a result, you need to join a Medicare Prescription Plan, also called Part D, to get drug coverage.
Almost all Medicare Advantage plans include drug coverage. But you should find out before enrolling because some don’t have the coverage. In this case, you need to join a separate Part D plan for it.
- Home or Abroad Coverage
Original Medicare offers health care access to enrollees anywhere in the United States. Medicare Advantage doesn’t guarantee healthcare coverage anywhere in the country because these plans are based around a network of providers, some of which may not be available at certain locations. So, if you travel around the country a lot, this might not be the best option for you.
Neither Medicare Advantage nor Original Medicare covers your medical expenses outside the United States. However, if you plan to travel abroad, you may be able to purchase supplemental insurance to access emergency care outside the country.
- Access to Medical Practitioners and Hospitals
You should find out whether hospitals close to your home accept medicare coverage before enrolling. Perhaps, you already have a personal physician; you should find out if they are a part of the plan’s network.
Original Medicare allows you to visit any doctor or hospital as long as they accept Medicare. As for Medicare Advantage, you have limited options. You can only use health care providers who are a part of the plan’s network. In this case, find out the network’s health care providers closest to you before enrolling.
Some Medicare Advantage plans offer out-of-network coverage to enrollees.
Conclusion
The choice of Original Medicare or Medicare Advantage (Part C) depends on you. What’s most important is identifying your health care needs and finding the right plan that fits.