Once you qualify for Medicare, you have some important decisions about how you’ll receive your health care benefits. Since 2003, seniors could opt for Part C, Medicare Advantage, for their healthcare plan instead of Original Medicare. The two versions provide varied opportunities for different levels of healthcare. In this blog post, we’ll discuss the two systems of coverage, their differences, and how to decide which is right for you.

It’s a choice between a federally run program and private insurance.

The original Medicare dates back to 1965, so Medicare Advantage is a more recent development. It allows people 65 and older to opt for private insurance, like an HMO or PPO, instead of the federally run program. When you sign up for Medicare, you must select three separate plans:

• Part A: hospital care, including in-patient stays, nursing care, hospice, and at-home nursing and healthcare.
• Part B: medical insurance, including primary care physician, outpatient, and some preventative services.
• Part D: prescription medical drug coverage.

As a Medicare member, you’re required to select plans from all three parts. You may have noticed that the plan names jump from B to D.

• Part C: Medicare Advantage is coverage through a private insurance company.

Medicare Advantage bundles A, B, and D together, so you don’t have to choose individual plans. You can choose a PPO or an HMO, just as you did when selecting health insurance through your employer.

There are substantial differences in coverage and cost.

One of Medicare’s major benefits is that you never have to worry about finding in-network providers or getting referrals for specialists. However, Medicare doesn’t cover cosmetic surgery, dental, vision, or hearing care. Medicare Advantage covers everything Medicare does, plus elective surgeries, dental, vision, and hearing. Some plans even cover gym memberships. A primary care physician will direct your care, so you’ll need referrals for specialists.

Both cover pre-existing conditions and offer plans for prescription drug coverage.
For cost, the federal government dictates premiums and deductibles for Medicare members. You’ll pay 20% of all your Plan B costs, but they cap deductibles for prescription drugs. Some people opt to get additional Medigap coverage, which helps ease the burden of Medicare out-of-pocket expenses because there’s no yearly cap.

Medicare Advantage members often experience lower out-of-pocket costs. Most providers have set copays and a yearly cap on overall out-of-pocket expenses. Members must still pay the federally mandated premium for Part B.

Deciding between Medicare and Medicare Advantage.

Picking the right Medicare plan is a deeply personal decision, and there are lots of components to consider. With Medicare, you have more choices, as you have to pick separate Part A, Part B, and Part D. Medicare Advantage simplifies the enrollment by bundling all the parts together in a single HMO or PPO.

Medicare allows members greater freedom in care, as almost all providers accept it, and you’ll never need a referral to see a specialist. The Advantage program runs your care through a primary care physician, so you must make sure your current doctor is in-network, or you may have to switch providers.

Selecting a private insurer through Medicare Advantage usually has lower out-of-pocket costs and provides more coverage, including hearing, dental, transportation to appointments, and even gym memberships.

Get in touch with Common Health to learn more about the difference between Medicare Advantage and Medicare.

If you’re interested in finding out what Medicare Advantage would mean for your health care, call Common Health. Our members enjoy a range of benefits, like 24/7 care teams available to answer questions, refill prescriptions, or schedule appointments. For issues that aren’t worth a trip to the doctor’s office, our members enjoy telemedicine benefits, receiving high-quality care from Common Health providers in the comfort of their homes. Your golden years are better when you’re a Common Health member. Get in touch with our team through our easy online form or call us at (877) 465-4494.