The Difference Between Medicare and Medicare Advantage

back in the 90s medicare beneficiaries had far  fewer choices than they do today for example   there were no medicare advantage plans in the  form that we had them now the only choice for   people with no retiree coverage from a former  employer was to enroll in original medicare   and add a medigap plan to help them cover  their deductibles co-pays and coinsurance   fortunately medicare beneficiaries today  have more choices they can opt to get   their medicare part a and b health care  services through a medicare advantage plan   and many of them do with approximately 42 percent  of them choosing medicare advantage plans today   but which one is right for you original medicare  or medicare advantage in this video i'll discuss   both options and share a few tips to help you  choose the right plan [Music] under original   medicare you get your benefits directly from the  federal government original medicare benefits   include two parts part a and part b that  provide your hospital and medical insurance   if you have a qualifying work history your part a  benefits are premium free medicare part b premiums   are set each year by the federal government  and most people pay the same standard rate   which is 170 and 10 cents in 2022. some high  earners pay an income related adjustment in   addition to the standard premium because original  medicare is managed by the federal government   the benefits are exactly the same for every person  who enrolls there are no pre-existing condition   limitations and no waiting periods part a covers  inpatient care while you are admitted to a   hospital or a skilled nursing home it also covers  hospice care and certain kinds of home health care   part b pays for outpatient expenses like doctor  visits x-rays and lab tests it also covers durable   medical equipment like wheelchairs and home  oxygen supplies under original medicare benefits   you can use any healthcare provider who accepts  original medicare this includes over 1 million   providers nationwide there are no networks you  pay the same amount for covered services from   any of these providers no matter which one you  visit for your medical care original medicare   does not cover outpatient prescription drugs  though you can enroll in a standalone part d   drug plan for that coverage think of part d as an  insurance card that you use only at the pharmacy   part d drug plans are offered by private  insurance companies but they are regulated   by medicare to ensure that all plans meet certain  minimum requirements with their drug formularies   if you choose to stay with original medicare  you need to know that there is no limit to   how much you might pay out of pocket each year  for example if you need chemotherapy your 20   co-insurance responsibility could be an awful lot  of money for this reason most people who choose   original medicare will also buy a medigap plan  medigap plans pick up where medicare leaves off   they step in to pay the deductibles co-pays and  coinsurance that you would otherwise have to pay   yourself most people who choose original medicare  plus a medigap plan value freedom of access   to medicare's entire list of providers  medicare offers the ultimate flexibility   for you to treat with any provider that  accepts medicare since there's no need to   choose a primary care provider you do not  have to get a referral to see a specialist   this kind of flexibility is appealing to many  people who travel frequently or live a snowbird   lifestyle because they can see doctors anywhere  they go other people choose original medicare and   medigap because they want very predictable  back end costs they want the peace of mind   that comes from knowing exactly how much they will  spend on a hospital stay or a chronic illness they   buy for convenience and don't mind spending a bit  more to gain peace of mind sometimes people also   choose original medicare if their doctors do not  participate in any of the medicare advantage plans   doctors have their own reasons for choosing not  to participate in medicare advantage network   sometimes if yours doesn't you'll have to  decide whether you want to keep original   medicare and pick up a medigap plan so you  can keep seeing that doctor or whether you   are willing to change to a new doctor who does  participate in the medicare advantage coverage   medicare advantage plans are very similar to  group health insurance that you've had during   your working years these plans have networks  and you pay for medical services as you go along   you must be enrolled in both medicare part a and  part b to enroll in a medicare advantage plan   medicare advantage is also known as medicare  part c so it's technically still a part of   medicare but plans are not offered directly  by the federal government the government sets   rules and guidelines for medicare advantage but  private insurance companies sell and administer   these plans medicare pays the insurance company to  administer your part a and b benefits through the   medicare advantage plan while all plans must cover  the same health care services as parts a and b   different medicare advantage plans will have  different networks co-pays and drug formularies   medicare advantage plans also do not require any  underwriting since there are no health questions   it's very easy to obtain a medicare advantage  plan if you live in the planned service area   and are enrolled in medicare parts a and b there  are several different types of medicare advantage   plans the two most popular medicare advantage plan  networks are hmo and ppo hmo plans have closed   provider networks and you generally must get all  but emergency care within your plan's network   you choose a primary care doctor who oversees  all of your medical care your plan may require   you to get a referral for a specialist care  and obtain prior authorizations for certain   tests and procedures hmo plans often include part  d prescription drug coverage rolled right into the   plan ppo plans also have provider networks but you  can still use any provider that accepts medicare   and is willing to build a plan however treating  with providers who are outside the network will   generally cost you more out of pocket with the ppo  plan you usually don't have to choose a primary   care doctor or need a specialist referral many of  these plans also include part d coverage now all   medicare advantage plans have to offer the same  health care services that you would get under   original medicare however many go beyond and offer  other coverage like routine vision and dental care   to their memberships some even have wellness  programs gym membership discounts and 24-hour   nurse hotlines it's difficult to give a snapshot  of your costs with a medicare advantage plan   because each one is different each company that  offers a plan can choose what to charge you for   premiums deductibles and copay amounts you may  have heard of a zero premium medicare advantage   plan a zero premium plan simply means that the  plan doesn't add any additional premium above   what you are already paying for part b for 2022  the average medicare advantage plan premium is   about 19 a month but in many urban areas you can  find plans with zero premiums for you to consider   some medicare advantage plans have deductibles and  others don't deductibles may apply to inpatient   services outpatient services or to medicare part  d about half of all medicare advantage plans with   part d benefits don't have a part d deductible  so if drug spending is anticipated you can try   looking for a plan in your area that has no drug  deductible for you to satisfy up front this is a   good thing since the part d standard benefit has  a 480 dollar maximum allowable deductible in 2022   however you may find that plans with the lowest  monthly premiums may have drug deductibles build   in there is a trade-off here which is why it's  so important for you to work with an experienced   broker like boomer benefits to help you choose  a plan that has the right balance of cost versus   benefits medicare advantage enrollees usually pay  a co-payment when they access healthcare services   this is usually between 10 and 50 for doctor  visits and up to 75 for emergency room and   urgent care visits there is often a tiered  co-payment system for prescription drugs   under the built-in party drug formulary generic  medications have lower co-payments often in the   three to five dollar range brand name medications  and specialty drugs have higher co-pays of course   there is one very important difference between  original medicare versus medicare advantage when   you have original medicare there is no limit to  your out-of-pocket expenses unless you purchase   a medigap plan to pay those expenses for you  within a medicare advantage plan you can't   purchase a medigap plan to pay your out-of-pocket  expenses you yourself will pay any co-pays   deductibles and co-insurance for this reason  medicare advantage plans are required by law   to build in a maximum out-of-pocket cap or loop  on your potential spending once you hit your moop   you pay nothing for covered part a and b health  care services for the rest of that calendar year   in 2022 the mandatory maximum out-of-pocket  limit for medicare advantage is 7 550 but   many plans choose to set theirs lower  choosing a plan with a lower maximum   out-of-pocket limit means your spending will  be capped sooner and that's good for you   so which type of plan is better for you original  medicare or a medicare advantage plan everyone's   situation is different so it's tough to give  a standard answer without knowing the details   that are most important to you both types of  coverage offer reputable medicare insurance   you just need to consider the total cost such as  premium deductible co-insurance and co-payments   and your health care needs to get a clear picture  many people are drawn to medicare advantage plans   because of those lower premiums however if you  encounter a serious or chronic health condition   you can sometimes incur some heavy spending  each year before you reach the plan's maximum   out-of-pocket limit always make sure to have some  money set aside to help you cover your co-pays   and co-insurance in the event that you develop  a chronic illness or have a year with heavier   medical usage for people who travel often the  restrictive networks with medicare advantage   could be a deterrent if you like to head south  to escape the cold each winter original medicare   will certainly provide you more freedom of  access to all the providers while you travel   in the united states paired with the medigap  plan your out-of-pocket costs under original   medicare will be much more predictable it's also  easy to find providers since original medicare's   network is nationwide in the end it's a good  idea to visit a reputable medicare insurance   broker like us here at boomer benefits to see what  plans are available in your area before you decide   that way you can compare costs and benefits  and see which option works best for you   there may be some things to consider that  you have not even thought of we'll go over   the pros and cons of medicare advantage plans  versus original medicare for you we'll help you   estimate your total medicare spending we can also  ensure that you use the proper election periods   for your medicare enrollment process to avoid  any unnecessary late penalties to learn more   about the features pros and cons of medicare  advantage plans watch this video next [Music] you

Channel: Boomer Benefits - Medicare Expert

Views: 40,482

Keywords: The Difference Between Medicare and Medicare Advantage, medicare vs medicare advantage explained, original medicare vs medicare advantage, medicare, medicare advantage, medicare advantage plans, original medicare, everything you need to know, medicare explained, we speak medicare, traditional medicare vs medicare advantage

Id: LAxReF4sC5w

Length: 12min 57sec (777 seconds)

Published: Sat May 21 2022