Medicare vs Medicare Advantage: A Comparative Guide

original medicare vs medicare advantage plans coverage

Are you confused about the pros and cons of getting Medicare or Medicare Advantage? Do you want to know if you need to change your Medicare plan to Medicare Advantage or which health insurance plan is better? 

The news about Sanders’s “Medicare for All” plan is putting a spotlight on the US healthcare industry. Yet, many people find the differences between Original Medicare and Medicare Advantage confusing. This Medicare vs Medicare Advantage guide aims to compare the two healthcare plans. 

This way, you have a better understanding of their differences and which is better for you. Keep reading to learn more about how different Medicare and Medicare Advantage are. 

What Is Medicare? 

In 1965, the government health insurance program created Original Medicare. Today, we refer to it as Medicare. The plan had two parts: Part A and Part B. 

Part A covers nursing facilities, nursing homes, and hospital insurance. Part B covers medical insurance as well as preventive care. This includes lab tests and medical equipment. 

Both parts come with deductible amounts, coinsurance, and copayments. Once you enroll in Medicare, you’re also enrolled in both parts of the plan. You're also automatically enrolled when you get Social Security benefits at 65 or become disabled. 

Original Medicare has no limits to which doctor or facility you go to. You can see any doctor or hospital that accepts Medicare and get coverage there. 

There are also some limitations that Medicare has. First, you don’t get covered by the healthcare plan when you travel outside of its service area. In some cases, often in emergencies, it may cover some services. 

Later, we will further discuss the pros and cons of Medicare vs Medicare Advantage. 

What Is Medicare Advantage? 

Medicare Advantage came a few decades later. In 1995, the government created it to provide more choices and benefits to the public. Some also use the name Medicare Part C or MA to refer to Medicare Advantage. 

Medicare Advantage provides a few added benefits to the Original Medicare plan. One of them is that it can cover more than traditional medical and hospital costs that Part A provides. Medicare Advantage includes plans that also cover dental, vision, hearing, and prescription drugs. 

This is only one of the reasons why Medicare Advantage is more popular than Medicare. However, there are a few things that people still don’t understand about the healthcare plan. One of them is that you may pay higher costs for specific services. 

Medicare Advantage also locks you in for the year once you enroll in it. There are some exceptions, like applying during a dis-enrollment period. If you miss it, you’re stuck with your Medicare Advantage plan. 

Medicare Advantage also limits the doctors and facilities it covers. You must know the providers and covered facilities before you get Medicare Advantage. You can view here a list of the companies and facilities that accept Medicare Advantage. 

Medicare vs Medicare Advantage: Key Differences 

Let’s take a closer look at the differences between the two healthcare plans. First, let’s talk about the covered services. Parts A and B are part of the coverage of both plans. As mentioned, Medicare Advantage also covers Part D (prescriptions) and then some. 

Where Medicare has no cap on what you pay out of pocket, Advantage has one. Once you hit a certain dollar amount, you don’t pay any more if you’ve got the Advantage plan. 

Medicare Advantage also covers you when you leave the country. However, it does not have the flexibility that Medicare offers. Original Medicare allows you to use your healthcare to cover costs for any doctor or facility. 

Questions on Medicare and Medicare Advantage 

We’ve laid out the basic coverage of Medicare and Medicare Advantage. Yet, we understand that you may still have questions about the two healthcare plans. We’ll do our best to find the most-asked questions and answer them. 

Is Medicare Advantage Better Than Traditional Medicare? 

In a sense, Medicare Advantage is better than traditional Medicare. However, you’d want to check each one’s pros and cons before you decide. Some people find that they’re happier with their Medicare plan than Medicare Advantage. 

Can I Switch Back to Medicare From Medicare Advantage? 

You can leave your Medicare Advantage plan and go back to Medicare. As mentioned, you need to apply for it during the dis-enrollment period. This is often from January 1 to February 14. 

Medicare and the Coronavirus Pandemic 

In 2018, 8.5% of the US population didn’t have health insurance. Now, the coronavirus is pushing people to consider how helpful having a healthcare plan is. 

The COVID-19 pandemic put on hold a lot of businesses and operations. Many people have to deal with staying locked in their homes for their safety. Yet, you can never be sure whether or not you’ve contracted this serious virus, especially if you’re asymptomatic. 

If you get diagnosed with COVID-19, Medicare will cover the hospitalizations. You also get covered if you’ve gotten quarantined. You’ll still have to pay for hospital deductibles, copays, and coinsurances that apply. 

Note that not all hospitals will charge you for Medicare. Military hospital ships and temporary military hospitals won’t charge Medicare. If you’re unsure, always make it a point to ask the hospital. 

Medicare will cover your COVID-19 lab test, which means you don’t have to pay any out-of-pocket costs. It also covers the COVID-19 antibody test. The COVID-19 antibody or serology test is the test for people who suspect they’ve gotten the infection. People with past or known prior COVID-19 infection can also take the serology test. 

Since there’s no vaccine for the COVID-19 virus yet, Medicare doesn’t offer coverage for it. However, it will cover the costs for the vaccine if it becomes available. 

All of these benefits apply to the Medicare Advantage plan as well. 

Get the Most Fitting Health Insurance Plan for You Now 

That is the end of our guide on the differences between Medicare vs Medicare Advantage. We hope you found some illumination on their key differences. We also hope that you now know how the Medicare plans or a Medicare Advantage plan suits your needs. 

Did you enjoy reading this guide on Medicare and Medicare Advantage? We’ve got much a lot of other posts like this for you. Feel free to check out our other guides for more helpful and useful content.

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