Enrollees can choose between Original Medicare and Medicare Advantage when they first enroll and each year during the Annual Enrollment Period.
Original Medicare consists of Part A and Part B .
Many Original Medicare beneficiaries also enroll in Part D and Medigap to increase their coverage and help with costs.
Medicare Advantage is an alternative to Original Medicare that offers at least the same amount of coverage. Enrollees usually get Part D included, as well as vision and hearing coverage.
A majority of Americans eligible for Medicare, over 30.8 million people, are now on Medicare Advantage plans.
That’s because, in many cases, it pays to not settle for what you have. You can change your coverage every year during the Annual Enrollment Period (Oct. 15 to Dec. 7).
On this page, we’ll give you a rundown on the main parts of Medicare insurance and how they feed into your two main enrollment options: Original Medicare and Medicare Advantage. Do you have the parts you need to get the most out of your Medicare benefits?
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Regardless of your current plan, you can update and change your Medicare plan each year to suit your current needs. This kind of annual decision starts with understanding that there are two main Medicare paths you can go down: Original Medicare and Medicare Advantage.
What’s the difference between Original Medicare and Medicare Advantage? Here’s an overview:
What is Original Medicare?
Medicare is government-funded health insurance that you enroll in through the Social Security Administration. Original Medicare includes:
Medicare Part A & Medicare Part B
- Standardized, income-based costs
- Can visit any doctor that accepts Medicare
To get adequate coverage, many Original Medicare customers also enroll in:
Medicare Part D
- Prescription drug coverage
Medicare Supplement Insurance (Medigap):
- Help control Original Medicare’s high out-of-pocket costs
What is Medicare Advantage?
Medicare Advantage plans are offered by private insurance companies and provide coverage that Medicare Parts A and B don’t.
Medicare Advantage (Part C)
- Provides at least the same coverage as Original Medicare
- Often will provide coverage through Part D
- Lower out-of-pocket costs
- Coverage is limited to provider networks
To get a better feel for your options, here’s a quick breakdown of the different parts of Medicare.
Medicare Part A
Part A is combined with Part B to create Original Medicare.
Part A provides coverage for inpatient stays at hospitals and other facilities such as skilled nursing facilities. It also includes home health visits and in-home hospice care.
Costs: How much you’ll pay is based on how long you or your spouse worked and paid taxes. If either of you worked 10 or more years, you probably don’t have a Part A monthly premium.
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Medicare Part B
Part B provides the medical portion of Original Medicare. This helps cover a long list of services that includes doctor visits, outpatient surgery, preventative health and home health.
Costs: Part B comes with a monthly premium that’s income based. Part B enrollees also pay copayments, coinsurance and a deductible. There is no out-of-pocket maximum.
Prescription Drug Plan (Part D)
If you’re in Original Medicare and need any medications to maintain your health, you can add Part D to help cover your prescription drugs. Many Medicare Advantage plans include Part D coverage.
Costs: Prices vary depending on your income and where you live. If you have Original Medicare, you’ll pay your Part D premium and adjusted amount separately.
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Medicare Supplement Insurance (Medigap)
You must be enrolled in Parts A and B to purchase Medigap. Medigap refers to a group of policies you can choose from to fill in the gaps in your Original Medicare coverage. This generally means helping with out-of-pocket costs like your copayments, coinsurance and deductible.
Costs: Medigap plan pricing varies by the plan and where you live. Each Medicare Supplement plan has its own premium and must be paid separately from your Original Medicare premiums.
Medicare Advantage (Part C)
If you’re enrolled in Parts A and B, you can choose to receive your Medicare from private insurance companies through Medicare Advantage. You’ll get at least the same benefits as with Parts A and B, but also the lower costs and extra coverages that Original Medicare enrollees get by adding Part D and Medigap plans.
Costs: Medicare Advantage plans vary by area and carrier.
As a Medicare Beneficiary, understanding how to get the most out of your plan is key to maintaining great health as you age. So is knowing what else is available. Check out our Medicare Beneficiary Guide to learn more about the ins and outs of your Medicare coverage, including costs, enrollment periods and much more.
If you still need help figuring out the different parts of Medicare and how they work together, give GoHealth a call. One of our licensed insurance agents will look at your needs and compare it to your current plan. Then we’ll shop and show you your options. After all, enrolling at 65 is just the start of your Medicare journey.
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