Medicare Advantage Plans vs Original Medicare: What Bend Residents Need to Know

Choosing the right Medicare Plan can feel overwhelming for Bend residents. With so many options to consider, it's crucial to understand the differences between Medicare Advantage Plans and Original Medicare. At Mountaintop Insurance Solutions, we're here to help make this decision easier for you. Let's dive into the key distinctions and what they mean for your healthcare coverage.

Understanding Medicare Advantage Plans

Medicare Advantage Plans, also known as Part C, are an alternative to Original Medicare. These plans are offered by private insurance companies approved by the federal government.

Include all benefits and services covered under Part A and Part B.
Often include extra coverage like vision, hearing, and dental.
May have lower out-of-pocket costs.

When you join a Medicare Advantage Plan, you still pay the Medicare Part B premium along with any additional premium required by the plan. These plans typically require prior authorization for certain services and may have a network of doctors and hospitals you must use.

What is Original Medicare?

Original Medicare includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). It is managed by the federal government and works differently than Medicare Advantage Plans.

Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services.

Original Medicare allows you to visit any doctor or hospital that accepts Medicare, without the need for prior authorization.

Switching Back to Original Medicare

If you're currently on a Medicare Advantage Plan and considering a switch back to Original Medicare, it's important to know the steps involved. During the annual open enrollment period, you can make changes to your Medicare coverage.

Consider whether you need a Medicare Supplement (Medigap) policy to help pay for out-of-pocket costs under Original Medicare.
Medigap Plans can help cover costs like coinsurance, copayments, and deductibles.

It's also essential to purchase a Medigap Plan when you first enroll in Medicare or during the Medigap open enrollment period to avoid higher premiums.

Medicare and Medicare Advantage: Comparing the Two

Both Medicare Advantage and Original Medicare have their own set of benefits and limitations. Here's a quick comparison:

Network: Original Medicare allows you to visit any healthcare provider that accepts Medicare, while Medicare Advantage Plans may have network restrictions.
Costs: Medicare Advantage Plans may offer lower premiums but could have higher out-of-pocket costs.
Additional Benefits: Many Medicare Advantage Plans include additional benefits like vision and dental, which Original Medicare does not cover.

Insurance Companies and Medicare Coverage

Insurance companies play a significant role in providing Medicare Advantage Plans. Each company offers different plans, so it's crucial to compare the options available in Bend, Oregon. Companies may offer plans with various coverage levels, benefits, and costs.

Before enrolling, compare the plans to find one that fits your healthcare needs and budget. Evaluate aspects such as covered services, out-of-pocket costs, and prescription drug coverage.

Frequently Asked Questions

Here are some common questions we receive at Mountaintop Insurance Solutions:

Do I still pay the Part B premium with Medicare Advantage? Yes, you'll need to pay the Part B premium along with any additional premium your Medicare Advantage Plan may require.
Can I switch from Medicare Advantage back to Original Medicare? Yes, you can switch during the Medicare Advantage Open Enrollment Period, which runs from January 1 to March 31 each year.
What if I can't afford a Medigap Plan? If a Medigap Plan is not affordable, consider a Medicare Advantage Plan that best suits your financial situation and healthcare needs.