Medicare

Original Medicare vs. Medicare Advantage

With so many available options, picking the right Medicare plan might seem overwhelming. But it may be less complicated than you think.

This year’s Medicare Annual Enrollment Period is October 15 through December 7. Whether you’re enrolling in a Medicare plan for the first time, or have a plan and would like to make changes, now is the time to start researching your options.

Let’s start with the basics. Medicare is health insurance that is available for people age 65 and older as well as those with disabilities. There are four parts: A, B, C and D. Parts A and B make up Original Medicare, Part C is Medicare Advantage and Part D is Prescription Drug Coverage.

Now, you may be wondering, which is right for me—Original Medicare or Medicare Advantage? Here’s how the two are different:

Original Medicare is provided through the federal government and gives access to hospitals, physicians and other health care providers. Here are a few key things to know.

  • It’s considered a fee-for-service plan, which means there’s not a cap on your out-of-pocket expenses—you’ll always pay about 20 percent of the cost of the services you receive. This can quickly add up depending on the amount of medical care required.
  • Original Medicare does not cover prescription drugs. Depending on your needs, you may need to add Part D or prescription drug coverage.
  • You can see any provider that accepts Medicare without worrying about what providers are in-network and out-of-network.

Medicare Advantage plans are offered through private insurance companies. These plans combine Part A and B under one plan, and often include prescription drug coverage too. Here’s what you need to know about these plans:

  • Most Medicare Advantage plans have an out-of-pocket maximum. This is the maximum amount you’ll pay for coverage of health care services during your plan year. Once the limit is reached, your plan pays 100 percent for all covered services.
  • Many Medicare Advantage plans offer additional benefits, such as SilverSneakers® Fitness, vision, hearing and dental coverage. This often makes Medicare Advantage plans a better overall value, especially because companies like Network Health offer Medicare Advantage plans for as low as $0 a month. So, you can get extra benefits without paying a large monthly premium
  • Although you must live within the plan’s service area, they often have travel benefits. For example, Network Health covers out-of-state medical expenses while you’re traveling and treats those expenses as in-network.

Now you’re ready to get into the plan details. I recommend people make a checklist that includes the things they consider most important and use it to match up with a plan that’s right for them. Here are some factors to consider.

  • The out-of-pocket maximum, which is the maximum amount you’ll pay for health care services in a plan year
  • Copayment amounts for seeing a primary care provider or specialist
  • How you use your medical benefits—for example, do you need to get a lot of routine lab tests? Or are you anticipating a surgery?
  • Medications and prescription drugs—what’s covered and how much it will cost when you fill the prescription?
  • Potential extra benefits, such as fitness, vision coverage, dental coverage, hearing aids and more

If you need help picking a plan, reach out to a Network Health sales advisor or broker. Both are great options for learning more about what options are available and how the different plans compare with each other. Network Health also offers in-person meetings and Zoom meetings for people to learn more about their Medicare options. You can learn more about these meetings at networkhealth.com.

Network Health Medicare Advantage Plans include MSA and PPO plans with a Medicare contract. NetworkCares is a PPO SNP plan with a Medicare contract and a contract with the Wisconsin Medicaid program. Enrollment in Network Health Medicare Advantage Plans depends on contract renewal.

Y0108_3049-01-0920_M Accepted 09252020