Medicare vs Medicare Advantage
By Susan Singleton, RHC Director
Understanding the difference between Traditional Medicare and Medicare Advantage
To help you understand your Medicare options before open enrollment begins October 15 we thought we would share some information about the differences between Traditional Medicare and Medicare Advantage.
Traditional Medicare and Medicare Advantage are not the same. Traditional Medicare, also referred to as Original Medicare, is funded and operated by the federal government. Medicare Advantage is funded by the government but operated by private insurance companies.
Traditional Medicare refers to Medicare Part A and Part B. Part A covers hospital care, including hospital stays, short-term skilled nursing care, hospice, and home health. Part B covers clinic and outpatient care with doctors and other health care providers and certain preventative services.
Medicare Advantage plans are offered by private insurance companies who are contracted by the federal government. Medicare Advantage, also referred to as Medicare Part C, covers the same healthcare services as original Medicare. Many Medicare Advantage plans also include prescription drug coverage and can also include coverage for routine vision, dental and hearing care. Health and wellness benefits, like fitness programs may be offered, as well.
Medicare Part D is prescription drug coverage. It is optional coverage to help Medicare beneficiaries pay for prescriptions.
Medigap supplement insurance may help pay some healthcare costs that original Medicare leaves to patient responsibility or does not pay for that specific service. This may include copayments, coinsurance, and deductibles. We recommend you call your insurance agent or the number on the back of your plan’s card to get your plan specific information.
Medicare is not mandatory. However, if you do not enroll for Medicare Part B (medical insurance) when you are first eligible, you may have to pay a higher premium cost. If you turn 65 and still have insurance through an employer or union, you can keep that insurance and wait to enroll in Medicare using a special enrollment period (SEP).
If someone who switched to Medicare Advantage less than 12 months ago are individuals in their first 12 months of Medicare Advantage enrollment, they will be eligible for a Special Election Period (SEP) that permits disenrollment from that Medicare Advantage plan to allow enrollment in an original Medicare plan. This can occur any time during the 12-month period that begins on the effective date of coverage in the Medicare Advantage plan. Medicare Advantage enrollees are eligible for this SEP if they elected a Medicare Advantage plan (other than an MSA plan) during their initial enrollment period (IEP) for Part B surrounding their 65th birthday.
Separate from the above SEP, Medicare beneficiaries who terminated a Medigap policy when they enrolled for the first time in an Medicare Advantage plan, regardless of whether they enrolled during their initial enrollment period (IEP) for Part B surrounding their 65th birthday, are eligible for a SEP to make a one-time election to disenroll from their first Medicare Advantage plan to join Original Medicare at any time of the year. The SEP begins upon enrollment in the Medicare Advantage plan and ends after 12 months of enrollment or when the beneficiary disenrolls from the Medicare Advantage plan, whichever is earlier. They have a guaranteed right to purchase another Medigap policy if they disenroll from the Medicare Advantage plan while they are still in a “trial period.” In most cases, a trial period lasts for 12 months after a person enrolls in a Medicare Advantage plan for the first time.
For help in understanding the difference between Traditional Medicare and Medicare Advantage Plans you can also call:
- Call SHIP (1.877.839.2675) or go to shiphelp.org. This line is free, open 24/7 and counselors are available to answer questions and give information about Medicare options.
Call 1.800.MEDICARE or go to medicare.gov to review and enroll in a Traditional Medicare plan.
