Medicare Advantage vs. Medicare: What’s the Difference?

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Medicare

Medicare is expected to have 59 million subscribers next year, but not all of them remain on Medicare A and B.

There’s an alternative to the original program: Medicare Advantage (Medicare C). For an extra premium, you’ll get access to all the same Medicare rights and benefits, but you’ll see a more straightforward plan and paperwork with a cap on yearly spending.

Are you curious about Medicare Advantage vs Medicare and the cost of staying healthy? Keep reading to see which program is right for you.

What Is Medicare Advantage?

Medicare Advantage, otherwise known as Medicare Part C, differs from traditional Medicare.

Whereas Medicare is run by the government, Medicare Advantage is offered by private insurance companies, typically preferred provider organizations (PPO) and health maintenance organizations (HMO).

To participate, you’ll pay the Medicare premiums required for enrollment in Original Medicare plus the plan’s premium, if there is one.

Under traditional Medicare, you can visit any care provider who accepts Medicare. When you choose Medicare Part C and receive a policy from a PPO or HMO, you’re limited to the providers outlined in your plan’s rules. HMOs and PPOs are known for setting their own rules for members.

Although Medicare Advantage doesn’t have the name recognition of traditional Medicare, it’s growing at an amazing clip. By 2018, it will serve over a third of total Medicare membership and provide plans to 20.4 million out of 59 million Medicare participants.

How Many Plans Are Available?

Plans vary by geographic location. The average qualifying program member is offered a choice of 21 different plans. Those living in major metropolitan areas and some counties may have 40 or more plans to choose from. Rural seniors are likely to see the fewest number of options on average.

Medicare Advantage vs Medicare: Choosing the Best Option:

Medicare Advantage differs from traditional Medicare in several meaningful ways. Although it is required to offer every service offered by Medicare, operators are allowed to offer additional memberships. For example, a provider may roll together Medicare benefits and Medicare Part D benefits to create a one-stop system for plan holders.

Several also offer added services like vision, hearing, and dental. These services are paid for out of pocket on other Medicare plans.

Here are a few other things to know about Medicare Advantage v Medicare:

The Medigap policy used to limit out-of-pocket costs is unavailable with Advantage. Many plans limit annual out-of-pocket costs instead, and Advantage pays the cost of care after you reach your limit.

You’re able to see doctors outside of your network, but you’ll be responsible for the costs of care.

Drugs are covered as part of the plan rather than requiring a separate Part D premium or Medicare supplemental insurance.

Your HMO or PPO may require a referral to see specialists.

The Bottom Line on Medicare Advantage:

If traditional Medicare isn’t right for you, then know you have options.

The differences between Medicare Advantage vs Medicare allow you to choose a plan that offers the same rights and benefits as Medicare while also allowing you to select an expanded program with the added benefits you need.

Do you have questions about Medicare Advantage? Share them with us in the comments below.

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