Is There Really a Difference Between Medicare and Medicare Advantage?

Open Enrollment

Medicare open enrollment for 2020 is from October 15 to December 7. Whether this is your initial enrollment or you simply want to make a change, the options can be confusing. We all want to make smart choices.

While many of us make decisions solely based on price, there are many things to consider that go beyond the amount of your monthly premium. The right decisions now can save you money and help you feel secure in the kind of care you’ll receive in the future.

Let’s break down the differences between Traditional Medicare (Part A, B, or D) and Medicare Advantage (Part C) below.


Fee For Service

Traditional Medicare:

You pay any provider who accepts Medicare with no approval required. You have a choice!

Medicare Advantage:

Negotiated: PPO or HMO choice is limited to providers in the service network.

Out of network: Insurance company will pay if the provider agrees to accept their fee. If they do, you may be subject to balance billing* from the provider.


Supplement

Traditional Medicare:

A Medigap supplement is required (typically $150 to $175).

Medicare Advantage:

Opting INTO Medicare Advantage: You must drop Medicare A/B and D, along with the supplement.

Opting OUT OF Medicare Advantage: Getting back into traditional Medicare A, B and D is not a problem, but you will be subject to medical underwriting for the supplement and possibly denied. The monthly cost is based on current age.


Premium

Traditional Medicare:

Most people receive Part A for free, but not all. For some, there may be monthly premiums and a monthly surcharge for Part B, Part D, & the supplement.

Medicare Advantage:

You pay for Part B. Depending on where you live, you may have no monthly premiums.


Prescription Drugs

Traditional Medicare:

A prescription drug plan is required. You are limited to your plan’s drug formulary**.

Medicare Advantage:

Prescription drugs are included in many plans, but not all.


Deductibles

Traditional Medicare:

Prescription deductibles vary, but no Medicare drug plan may have a deductible more than $435 in 2020.

Medicare Advantage:

Prescription deductibles are waived in most plans.


Coverage Gap

Traditional Medicare:

Once you and your plan have spent $4,020 on covered drugs in 2020, you are in the coverage gap.

Medicare Advantage:

There is no gap, but you are limited to their drug formulary**.


Extra Benefits

Traditional Medicare:

You are only covered for vision, dental, or hearing if it relates to a medical diagnosis.

Extra benefits may be available through the supplement.

Medicare Advantage:

Extra benefits are available, depending on the plan & subject to change annually.

  • Dental, vision, glasses, hearing aids
  • Preventive services like Silver Sneakers
  • Home delivered meals
  • Private nursing after hospitalization

Rehabilitation & Skilled Nursing

Traditional Medicare:

You can select any participating provider.

Medicare Advantage:

You may only use an approved provider.


Durable Medical Equipment

Traditional Medicare:

You can select any participating provider.

Medicare Advantage:

You may only use an approved provider.


Medical Treatments

Traditional Medicare:

Medicare will generally pay for treatments prescribed by your doctors.

Medicare Advantage:

There are service limitations. For example: Your doctor feels hyperbaric treatment will heal your wound, but it will likely be declined based on age and medical history.


Emergency Services

Traditional Medicare:

You are covered anywhere in the US and abroad.

Medicare Advantage:

You may not be covered. Each plan is different.


Service Out of Area

Traditional Medicare:

Medical care outside of the service area (e.g. travel abroad, vacation home) is covered.

Medicare Advantage:

Medical care outside of the service area (e.g. travel abroad, vacation home) may not be covered.


Are you still feeling nervous or confused when choosing the right Medicare coverage?

With expertise in Medicare and health insurance, our Protective Aging program gives you a partner in understanding your specific needs. Talk with a professional and feel confident that you’ve chosen the best coverage for you and your family.

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