Do I Still Pay Original Medicare Premium If I Have Medicare Advantage Plan
Turning 65 means becoming eligible for Medicare. But once you qualify, determining the best Medicare path can feel like navigating a maze. Medicare Advantage and Original Medicare represent the two main options, and understanding how they differ is critical for making the right choice. This guide breaks down the key contrasts so you can select optimal coverage.
A Brief Medicare Refresher
Before diving into the Medicare Advantage and Original Medicare comparison, let’s review some Medicare basics:
- Part A: Hospital insurance covering inpatient stays, skilled nursing, hospice, and home healthcare. Most people don’t pay a premium for Part A.
- Part B: Medical insurance covering doctor visits, outpatient care, preventive services, and durable medical equipment. You pay a monthly premium for Part B.
- Part C: Also called Medicare Advantage, these plans are offered by private insurers and bundle Parts A, B, and usually D.
- Part D: Prescription drug coverage available as stand-alone plans offer or included in most Medicare Advantage Plans. You pay a separate monthly premium.
Now, let’s contrast Medicare’s two primary avenues.
Medicare Advantage: A Private Approach
Medicare Advantage represents an alternative way to get your Medicare benefits. Here’s an overview:
- Comprehensive coverage: Includes Parts A, B, and usually D in one plan. Some plans also cover extras like vision and dental.
- Fixed costs: Out-of-pocket limits cap your expenses, and some plans have $0 premiums beyond your Part B premium.
- Network restrictions: You generally must use in-network providers except in emergencies. Referrals may also be required to see specialists.
- Enrollment periods: You can only join, switch, or drop a Medicare Advantage Plan during certain times of year.
- Plan availability: Options vary by location. Medicare Advantage may not be available where you live.
- Pre-approval requirements: Your plan may require prior authorization for certain services before they’re covered.
- Medicare oversight: Plans must cover all medically necessary services, but can have different costs and rules.
Original Medicare: The Traditional Route
Original Medicare is the government-administered foundation of the Medicare program:
- Parts A and B only: You must get separate Part D prescription drug or supplemental coverage.
- Freedom to choose providers: See any healthcare provider nationwide that accepts Medicare. Referrals are generally not needed.
- Stable costs: Premiums and coverage rules are set by Medicare and change little year-to-year.
- No networks: Your Medicare card is accepted everywhere so there are no in or out-of-network restrictions.
- Travel coverage: Original Medicare works across the United States. Medicare Advantage has limited out-of-area coverage.
- No pre-approvals: You don’t need your plan’s permission to get medically necessary care like with some Medicare Advantage Plans.
- Higher out-of-pocket costs: 20% coinsurance for Part B services, hospital copays, and no yearly limit on your expenses.
Key Differences to Understand
Part B premium only
May have $0 premium or help pay Part B
Out-of-pocket spending limit
$8,300 in 2023
Doctor and hospital limitations
None, as long as they accept Medicare
Restricted to plan’s network only
Referrals required for specialists
May be required
Prescription drug coverage
Must get separate Part D Plan
Dental, vision, hearing coverage
Must buy separate plans
Health club membership
May be included
Worldwide emergent coverage
As shown above, Medicare Advantage and Original Medicare differ significantly in terms of costs, coverage, and healthcare access.
Pros and Cons of Medicare Advantage
Medicare Advantage offers advantages:
- Lower out-of-pocket costs
- Prescription drug coverage included
- Extra benefits like dental and vision
- Out-of-pocket spending cap for peace of mind
- Limited provider network
- Need referrals and pre-approvals
- Difficulty seeing specialists at top hospitals
- Hassle and delays getting care approved
- Coverage problems when traveling
Pros and Cons of Original Medicare
Original Medicare also has pluses and minuses:
- Freedom to choose any healthcare provider nationwide
- Use any hospital including top-ranked institutions
- Get care without referrals or pre-approvals
- Reliable coverage when traveling
- Less prescription drug formulary restrictions
- No yearly limit on out-of-pocket spending
- Must buy separate drug and supplemental plans
- Pays 80% of Part B expenses after you meet deductible
- Doesn’t cover vision, dental, hearing, or fitness
As shown above, both options have trade-offs to weigh. Choose the one that best aligns with your healthcare priorities.
Your specific costs will depend on the plan, but here’s an overview of how Medicare Advantage and Original Medicare generally compare:
- Premiums: Medicare Advantage may have $0 premium or help pay part of your Part B premium. With Original Medicare, you must pay full Part B costs.
- Deductibles: Original Medicare includes Part A and Part B deductibles. Most Medicare Advantage Plans don’t have deductibles.
- Coinsurance: Original Medicare has 20% coinsurance for Part B services after the deductible. Medicare Advantage may have lower coinsurance.
- Copays: Medicare Advantage typically charges copays for services that have coinsurance under Original Medicare. Copays are predictable amounts.
- Out-of-pocket limit: Medicare Advantage has a yearly limit on your expenses for Part A and B care. With Original Medicare, your costs are unlimited.
- Drug costs: Medicare Advantage drug copays and coinsurance may be higher than stand-alone Part D Plan options.
Carefully weigh the costs and benefits when choosing what’s right for your situation. In some cases, higher premiums buy you more healthcare freedom.
Should You Choose Medicare Advantage or Original Medicare?
There’s no universally “right” option. Here are a few key questions to help decide:
- How important is keeping your current doctors and hospitals? Original Medicare offers more provider choice.
- Do you need regular specialist care? Medicare Advantage may require referrals and pre-approvals.
- Will you travel often? Original Medicare has better nationwide and overseas coverage.
- What is your prescription drug situation? Stand-alone Part D Plans can offer more affordable options.
- Are your out-of-pocket costs manageable? Medicare Advantage limits spending.
- Do you want extras like dental coverage? These benefits are usually only in Medicare Advantage.
Talk to a Medicare broker or your State Health Insurance Assistance Program (SHIP) to walk through your options in more detail.
- Medicare Advantage Plans combine Parts A, B, and usually D in one policy from a private insurer.
- With Original Medicare, you get coverage directly from the federal government through Parts A and B.
- Medicare Advantage features provider networks, pre-approvals, more benefits, and out-of-pocket spending limits.
- Original Medicare allows you to see any doctor nationwide and get care without pre-authorizations.
- Study the pros, cons, costs, and coverage to determine if Medicare Advantage or Original Medicare is the smarter choice based on your needs.
Selecting the right Medicare path takes diligent research. But with this breakdown of the differences between Medicare Advantage and Original Medicare, you have a solid foundation for making.
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Do I still pay the Original Medicare Part B premium if I have a Medicare Advantage Plan in 2023?
Yes, you must continue to pay your Part B premium if you enroll in a Medicare Advantage Plan. Many Medicare Advantage Plans have a $0 premium, meaning you do not have to pay an additional monthly premium on top of your Part B premium. However, some plans may charge a monthly premium for additional benefits or lower out-of-pocket costs. It’s important to check with your specific plan for details on the premium.
What is a premium?
A premium is the amount of money you pay on a regular basis to have health insurance coverage. In the context of Medicare, it refers to the monthly payment you make to maintain your Medicare Part B coverage.
What is a Medicare Advantage Plan?
A Medicare Advantage Plan, also known as Medicare Part C, is an alternative to Original Medicare (Part A and Part B) offered by private insurance companies approved by Medicare. These plans cover all the benefits of Original Medicare and often include prescription drug coverage (Part D) as well. Medicare Advantage Plans may also offer additional benefits beyond what Original Medicare covers, such as dental, vision, hearing, and fitness programs.
Do Medicare Advantage Plans cover the same services as Original Medicare?
Yes, Medicare Advantage Plans are required to cover all the same services that Original Medicare covers. This includes medically necessary and preventive services. However, the specific covered services may vary between plans, so it’s important to review the plan’s documents or contact the plan directly to understand the coverage details.
Do I still have to pay my Medicare Part B premium if I enroll in a Medicare Advantage Plan?
Yes, you must continue to pay your Part B premium if you enroll in a Medicare Advantage Plan. While some Medicare Advantage Plans have a $0 premium, meaning you do not have to pay an additional monthly premium, you still need to pay your Part B premium to remain enrolled in Medicare and access the covered services.
Are there any additional costs associated with Medicare Advantage Plans?
Yes, Medicare Advantage Plans may have additional costs known as cost sharing. This includes copayments, coinsurance, and deductibles for services received. The specific cost-sharing details vary between plans, so it’s important to review the plan’s documents or contact the plan directly to understand the potential out-of-pocket costs.
Can a Medicare Advantage Plan help pay for my Part B premium?
No, Medicare Advantage Plans cannot directly help pay for your Part B premium. The Part B premium is paid separately to Medicare. However, some Medicare Advantage Plans may offer supplemental benefits or cost-sharing reductions that can help reduce your overall healthcare expenses.
What does the term “cost sharing” mean in relation to Medicare Advantage?
Cost sharing refers to the portion of healthcare expenses that you are responsible for paying out of pocket in addition to your premium. This includes copayments, coinsurance, and deductibles. Medicare Advantage Plans may have different cost-sharing structures and rules, so it’s important to review the plan’s documents or contact the plan directly to understand how cost sharing works.
Will I still be covered by Original Medicare for certain services if I enroll in a Medicare Advantage Plan?
Yes, even if you enroll in a Medicare Advantage Plan, you will still have coverage under Original Medicare for certain services. These services typically include hospice care and some types of kidney dialysis or transplant services. If you require these specific services, you will receive coverage from Original Medicare rather than your Medicare Advantage Plan.
What happens to my Medicare Supplement if I enroll in a Medicare Advantage Plan?
If you enroll in a Medicare Advantage Plan, you cannot use your Medicare Supplement (also known as Medigap) to pay for out-of-pocket costs under the Medicare Advantage Plan. You must also continue to pay your Medicare Supplement premium, as it only works in conjunction with Original Medicare, not Medicare Advantage.
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