At a family reunion, my Aunt Abby and Uncle Glen got into a squabble over the best way to get their Medicare benefits.
Uncle Glen is an Original Medicare man, and has been for a decade or so. Aunt Abby prefers Medicare Advantage, which is similar to a health plan she had before enrolling in Medicare.
When they turned to me, asking me to referee and declare which form of Medicare is better, I gave them a big smile and answered, “Well, it depends.”
Original Medicare and Medicare Advantage have different benefits and costs that you should consider based on your personal needs. Medicare open enrollment season runs from Oct. 15 to Dec. 7, and it’s a good idea to know how the two types of Medicare work before you select one.
With Original Medicare, you can choose any doctor, hospital, or other healthcare provider you want, as long as they accept Medicare. When you receive medical services or goods, Medicare pays the provider directly. About 70 percent of all people with Medicare have Original Medicare.
The other way to get your benefits is Medicare Advantage, which is a form of managed care, like an HMO or PPO. Medicare Advantage is provided by private insurance companies approved by Medicare. If you’re in Medicare Advantage, you generally must go to doctors and other providers in the company’s network.
If you go outside the network, you may have to pay more.
On the other hand, Medicare Advantage plans may offer some services — such as dental, hearing, vision, and prescription drug coverage — that Original Medicare doesn’t.
Most people with Original Medicare pay a monthly premium. If you’re in Medicare Advantage, you may have to pay an additional monthly premium to the private insurer that covers you.
With Original Medicare, you or your supplemental insurance must pay deductibles, co-pays, and coinsurance.
To cover these “gaps” in Medicare, some people buy supplemental insurance called Medigap. If you have a Medigap policy, Medicare pays its share of the covered costs, and then your Medigap policy pays its share.
Original Medicare doesn’t cover prescription drugs. If you want drug coverage, you can buy a separate Medicare Part D plan. Such plans are sold through private companies approved by Medicare. You have to pay an additional monthly premium for Part D.
To see the full story, subscribe to our print or e-edition. For more information please call The Reedley Exponent at 559-638-2244.