Medicare Advantage is a viable alternative to Original Medicare. Its strengths are its comprehensiveness and added benefits, but it also has its drawbacks.
Medicare Advantage vs. Original Medicare
Medicare Advantage combines Medicare Parts A, B, and D (in most cases) into one convenient health insurance plan. Original Medicare solely consists of Medicare Parts A and B. You still have to have Medicare Parts A and B in order to join Medicare Advantage.
Both Medicare Advantage and Original Medicare cover inpatient treatments, such as hospital stays. They also cover outpatient treatments such as office visits, and durable medical equipment.
Medicare Advantage is different from Original Medicare in that:
- Medicare Advantage is only offered through private insurance
- It has additional benefits such as gym memberships, as well as dental, vision, and hearing coverage
- Not every hospital that accepts Medicare will accept Medicare Advantage
- Medicare Advantage can assist in paying Part B premiums
- Prescription drug coverage is included in some plans
Types of Medicare Advantage plans
Medicare Advantage comes in many forms. This includes:
- Health Maintenance Organization (HMO)
- Preferred Provider Organization (PPO)
- Private Fee-for-Service (PFFS)
- Medicare Savings Account (MSA)
- Special Needs Programs (SNP)
Medicare Advantage limits policyholders to get coverage within a specific network of providers. While you can go out-of-network to get treatment at a higher cost, an out-of-network healthcare provider may also refuse to treat you.
You may also have to choose a primary care physician, from whom you will need a referral before you can see a specialist. Your coverage will not apply if you try to see a specialist on your own without the referral.
Medicare Advantage is also a plan you must have by itself. Joining Medicare Advantage if you’re on an employer group health insurance plan can lead to you losing your group health coverage. You may not be able to get the group health coverage back after that. You also cannot enroll in a Medicare Supplement plan.
When to enroll
You can join a Medicare Advantage plan around the time when you turn 65, during your Initial Enrollment Period. It’s a seven-month time span between three months before you turn 65 to three months after you turn 65.
Another option is during the Open Enrollment Period, which lasts from October 15 to December 7. You have to have to be enrolled in Original Medicare prior to this. If you missed your Initial Enrollment Period, you will have to wait until the General Enrollment Period (January 1 to March 31) to join Original Medicare. Then you can switch from Original Medicare to Medicare Advantage during the Open Enrollment Period of that year.
Taking the next step
Heritage First puts you first when it comes to Medicare coverage. We can answer any questions about any Medicare-related topic, and help you obtain a Medicare Advantage policy that fits your physical and financial needs.