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Medicare is confusing and complicated to most people, especially seniors. As your trusted Medicare broker, don’t hesitate to contact our experts at Medicare Sharks if you need help understanding the various Medicare options.
Medicare insurance coverage offers benefits through three major parts: A (Hospital), B (Medical), and D (Prescription Drugs). Each of these coverage can be provided via the two main Medicare options, Original Medicare (Parts A & B) and Medicare Advantage Plans (Part C).
The main Medicare options are Original Medicare and Medicare Advantage Plan.
Original Medicare coverage entails Part A (Hospital insurance) and Part B (Medical Insurance). Original Medicare is the traditional fee-for-service program that is offered directly via the federal government. You may have heard the phrases Traditional Medicare or Fee-for-Service (FFS) Medicare. Both these refer to the Original Medicare option. If you need drug coverage, you can also combine a separate Medicare Drug Plan option, also known as Part D.
Commonly, most clients choose to receive their Part A and Part B Medicare benefits through the Original Medicare Option.
If you have this plan and need care, you go directly to the physician or hospital. You don’t have to get prior authorization from Medicare or your primary care physician.
You may be required to pay a monthly premium to access your Part A and Part B benefits. So usually, you pay a coinsurance for each service you receive. So you pay for the services as you get them. When you receive a covered service, you pay your share, while Medicare pays PartPart of the cost.
In the Original Medicare option, there are limits on the amounts that health providers and hospitals can charge for your care.
Those who want their prescription drugs to be covered under the Original Medicare option will have to actively choose the stand-alone Medicare Prescription Drug Plan (Part D).
You can also add supplemental coverage through the Medicare Supplement Insurance (Medigap) coverage, where a former employer, a union, or Medicaid can help to pay your share of costs.
In the Original Medicare Option, your coverage enables you to visit nearly all health providers and hospitals in the country.
It is wise to choose a Medicare option that is suited to your needs and favorable for your pockets. Depending on certain eligibility criteria, there exists a number of government programs that may help reduce your health care and prescription drug costs. By talking to the right Medicare insurance broker, you will get the needed help in understanding the appropriate Medicare option for you.
Unless you actively choose the Medicare Advantage Plan option, you will most likely have the Original Medicare option.
The Medicare Advantage Plan is also known as Medicare Part C and is offered by private carriers. For this reason, it is also known as Medicare Private Health Plan.
You can decide to get additional coverage and benefits through this Medicare option. It is an alternative to the Original Medicare coverage option for your medical and drug coverage. Part C is usually a bundled plan containing Part A, and B and often Part D.
You choose a Medicare-approved plan from a private carrier that offers an alternative Medicare option. Remember that you can only use providers who are part of the plan’s network.
Know that you still have the Original Medicare Plan even if you enroll in the Medicare Advantage Plan. Therefore, you still have to pay your monthly Part B premium and PartPart A premium if you choose it.
Although the Medicare Advantage Plan must provide services covered by Part A and Part B in the Original Medicare option, it can do so with varying rules, restrictions, procedures, and costs that can affect how and when you receive care.
It is necessary to understand your Medicare options and choose your preferred coverage carefully. The way you choose your benefits and who you get them from can significantly impact your out-of-pocket costs and where to access your care.
Contrary to the Original Medicare option, the Medicare Advantage option has more network restrictions. You are more limited in your choice of hospitals and doctors. On the upside, the Medicare Advantage Plan options can provide additional benefits such as routine dental and vision checkups, which are not covered by the Original Medicare option.
If you need help understanding Medicare options in various combinations optimized to your needs, Medical Sharks has got you covered. Read below for more options.