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When you first sign up for Medicare, and during certain times of the year, you can choose on how you get your Medicare coverage. There are 2 main ways to get Medicare.
Original Medicare
Original Medicare is a federal health insurance program provided by the government to individuals who are 65 years or older, those who have certain disabilities, and those with end-stage renal disease (ESRD). The program provides comprehensive medical coverage and includes two main components: Part A (hospital insurance) and Part B (medical insurance).
Part A covers inpatient hospital care, hospice care, and some limited home health services. It also covers skilled nursing facility care, but only under specific conditions. Part B covers medical expenses such as physician services, laboratory tests, medical equipment, and outpatient hospital services.
Original Medicare does not cover all medical expenses. For example, it does not cover routine dental, vision, or hearing care, or prescription drugs. To supplement Original Medicare, individuals can purchase additional coverage, such as Medicare Supplement Insurance (Medigap) or a Medicare Advantage Plan (Part C).
Individuals who are eligible for Original Medicare are automatically enrolled, but they must also enroll in Part B within the first six months of receiving Medicare eligibility. There is a monthly premium for Part B, which is usually deducted from the individual’s Social Security benefit.
The federal government administers original Medicare, and no health maintenance organizations (HMOs) or networks are involved. This means that individuals are free to see any doctor or specialist who accepts Medicare, anywhere in the country.
Medicare Advantage plans
Medicare Advantage plans are private health insurance plans that are approved by Medicare and offer the same benefits as Original Medicare. Medicare Advantage plans, also known as Part C, provide a convenient and cost-effective alternative to Original Medicare, as they usually cover additional services such as routine dental, vision, and hearing care, as well as prescription drugs.
Individuals who are eligible for Medicare can enroll in a Medicare Advantage plan during their Initial Enrollment Period (IEP) or the Annual Enrollment Period (AEP). To enroll in a Medicare Advantage plan, individuals must first be enrolled in both Part A and Part B of Original Medicare.
Medicare Advantage plans vary in terms of coverage, cost, and network restrictions. Some plans are offered by health maintenance organizations (HMOs) and require individuals to use specific healthcare providers within their network. Other plans, such as preferred provider organizations (PPOs) or private fee-for-service plans, allow individuals to see any healthcare provider who accepts Medicare.
In terms of cost, Medicare Advantage plans typically have a monthly premium, as well as an annual deductible, copayments, and coinsurance. However, some plans may offer low or no monthly premiums, making them a cost-effective option for individuals on a tight budget.
Medicare Advantage plans also offer additional benefits, such as wellness programs and routine preventive care, which are not covered by Original Medicare. They also provide a comprehensive package of benefits, including medical and prescription drug coverage, which makes it easier for individuals to understand their health insurance coverage.
