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Understanding Medicare: Original Medicare vs. Medicare Advantage

There’s a ton of information out there about Medicare, but sometimes making sense of it all can be the hardest part. We’re breaking it all down to help make it easier, from Original Medicare and Medicare Advantage to all the different “parts” of Medicare explained. Here’s what you need to know.

The Parts of Medicare Explained

Medicare has 4 parts that cover different medical needs. There are 2 main options for Medicare coverage: Original Medicare (Parts A and B) and Medicare Advantage (Part C). When making decisions about your coverage, it’s important to understand these options as well as Medicare prescription drug coverage (Part D). Let’s take a look at what each part of Medicare covers.

Medicare Part A

Part A helps cover the big stuff, like:

  • Hospitalization
  • Skilled nursing facility
  • Hospice care
  • Home health care

Most people age 65 or older are eligible for Part A thanks to payroll deductions that were taken during your working years. When you’re turning 65 and anytime after, you’re eligible for Part A even if you’re still working. If you aren’t automatically enrolled, you can sign up for free Part A if you’re eligible at any point during or after your Initial Enrollment Period.

Medicare Part B

Part B helps cover routine care, like:

  • Doctor appointments
  • Outpatient care
  • Many preventive services
  • Durable medical equipment
  • Occupational/physical therapies
  • Home health care

To qualify for Part B, you must enroll when you’re turning 65 and pay a monthly premium to avoid paying extra or having a gap in your coverage. Most people choose to have their Part B premium automatically withdrawn from their monthly social security check.

If you’re delaying your retirement and have insurance with your employer, you can delay your enrollment in Part B. However, if this is not the case and you don’t enroll when you first become eligible for Part B, your Part B premium may be higher and you may pay a late enrollment penalty.

Medicare Part C

Part C is Medicare Advantage, like the plans offered by us at Clover Health. Medicare Advantage plans must all include Part A and Part B benefits, and many Medicare Advantage plans offer additional benefits like:

  • No or low monthly premiums
  • Extra benefits and services like prescription drugs, dental, vision, and wellness

Medicare Advantage plans usually have lower out-of-pocket expenses than Parts A and B. Medicare Advantage plans are also reviewed and approved by Medicare. You must be enrolled in both Medicare Parts A and B to join a Medicare Advantage plan.

Medicare Part D

Part D is prescription drug coverage. It covers things like:

  • Prescription drugs
  • Many recommended shots and vaccines

Part D coverage may be offered as a stand-alone plan or as part of a Medicare Advantage with Prescription Drug (MAPD) plan. All plans must meet the minimum coverage level set by Medicare.

Similar to Part B, if you don’t sign up for Part D when you’re first eligible, the premium amount will increase each month until you enroll. These plans are offered by private companies approved by Medicare. Many Medicare Advantage plans include prescription drug coverage that follows the same rules as Medicare prescription drug plans.

What’s the Difference Between Original Medicare and Medicare Advantage?

Original Medicare includes Parts A and B. Medicare Advantage plans like those offered by Clover Health must include all Part A and Part B benefits as well; however, some Medicare Advantage plans include extra benefits in their plans. And unlike Original Medicare, Medicare Advantage plans offer a cap on what you pay out of pocket each year.

Medicare Advantage plans are offered through private companies, like Clover Health, which contract with Medicare and must have all the benefits of Original Medicare (Parts A and B). With many Medicare Advantage plans, you get a health plan, prescription drug coverage, and additional benefits, like dental, vision, hearing, wellness, and more—all with $0 or low monthly premiums. Plus, Medicare Advantage plans usually have lower out-of-pocket expenses. With Medicare Advantage, you wouldn’t need a high-premium Medigap plan.

Medicare Advantage is convenient and easy: one plan, one card, one premium, and one company. That’s why more than 22 million Medicare beneficiaries already have one.

Benefits of Medicare Advantage

When you choose a Medicare Advantage plan from a private insurance company, you can have peace of mind knowing…

  • You are still enrolled in Medicare.
  • Every Medicare Advantage company has a contract with Medicare.
  • Every plan includes all Part A and Part B benefits.
  • Plans have a yearly limit on what you pay out of pocket for Medicare Part A- and B-covered services.
  • Every plan is reviewed and approved by Medicare each year.

You must be enrolled in both Medicare Part A and Part B to join a Medicare Advantage plan, which then is used for your healthcare needs. With Medicare Advantage, you choose to have your benefits administered by a private company.

We hope this information has been helpful to you as you weigh your healthcare options. To learn more about Medicare or Clover Health’s Medicare Advantage plans, please give us a call at 1-855-203-1461 (TTY 711) 8 am–8 pm local time, 7 days a week.*

Want to learn more about Medicare? Check out the following articles to answer your questions.

What Are My Medicare Options?

How to Choose a Medicare Plan

How Does Medicare Advantage Work?

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