Explaining Medicare Benefits

There is a lot of confusion regarding the difference between “original” Medicare and Medicare Advantage.  This article will discuss the basic differences to help you understand what coverage is available and which plans are appropriate for you.

Medicare is made up of two basic categories Medicare (Original Plan) and Medicare Advantage Plan.  Both plans have supplemental categories including Part A, B, C, and D. 

The original plan includes Part A.  You an add part B and D if you choose to. You will automatically be enrolled in original Medicare when you turn 65, unless you decide to choose Medicare Advantage (Part C).  The Original Medicare Plan is managed by the federal government as a fee-for service plan with various options and co-pays. 

The Medicare Advantage plan combines Part A and Part B and is provided by and managed by private insurance companies.  If Part D coverage, which covers prescription drugs, is not included with the plan you purchase, you can purchase it as a separate supplement. 

If you choose to Medicare Advantage plans, there are several types of coverage, including HMO, PPO, plans that include private fee-for-service, and Medicare special needs plans.

Part A covers hospital expenses and does not charge a premium.  It also covers inpatient care in skilled nursing facilities, critical care hospitals, regular hospitals, hospice services and hoe health care services.

Part B pays for medically necessary services and supplies covered by Medicare.  There is a premium for this coverage for most people.  Part B covers outpatient, doctors, physical and occupational therapists and additional home health care.

Part C I the Medicare Advantage Plan which covers Part A and B.  Though it is provided by private insurance companies, it is still overseen and approved by Medicare.  With this program you may have lower costs and usually receive extra services.

Part D is prescription coverage which is a stand-alone plan.  Most people pay a premium for this coverage and all medically necessary drugs are covered.  There are different plans that cover different drugs.  It is important to compare plans to be sure what coverage is best for you.

To be certain that you have the correct coverage, it is best to contact Medicare at 1-800-MEDICARE r visit them on the web at www.medicare.gov.

Filed under: General-Medicare

Tags: benefits, General-Medicare, medicare advantage, part a, part b, part d