What’s the Difference Between Original Medicare and Medicare Advantage?
Original Medicare is a health plan administered by the federal government. It’s also known as Medicare Part A and Medicare Part B,. With Original Medicare, you work with any doctor or healthcare provider accepting Medicare. And you don’t need referrals to see a specialist, so long as that specialist accepts Medicare.
You can also add a Medigap policy to your health plan. Medigap is also known as Medicare Supplement Insurance.
Medicare Part C, or Medicare Advantage, works in a different way. With Medicare Advantage, you get health insurance through a private health insurance company. That health plan must follow guidelines from the Centers for Medicare & Medicaid Services (CMS). It must offer at least the same coverage as Original Medicare.
With Medicare Advantage, you work with doctors and providers within your healthcare network. You may need a Primary Care Physician (PCP) to recommend you to see a specialist. And you may need to follow other network guidelines.
However, most Medicare Advantage plans offer additional benefits. That means coverage and services not available to Original Medicare beneficiaries.
You can’t have both Medicare Advantage and Medigap. With either plan, you can add Medicare Part D so long as you don’t already have prescription coverage.
Can You Switch Back To Medicare From Medicare Advantage?
Yes. You can switch back during the Fall annual election period (AEP). You can switch back sooner if you qualify for a special enrollment period (more on this below).
What’s Medigap and What’s the Big Deal About Losing Medigap?
Medigap is like buying extended coverage for Original Medicare. Medigap helps you cover out-of- pocket costs of coinsurance, copays, and deductibles. There are several types of Medigap policies to choose from:
Medigap Plan A
Medigap Plan B
Medigap Plan C *
Medigap Plan D
Medigap Plan F *
Medigap Plan G
Medigap Plan K
Medigap Plan L
Medigap Plan N
* Please note that Medigap Plans C and F are no longer available to new Medicare beneficiaries. If you already have either Medigap plan and you leave the plan, you will not be able to re-enroll.
When you first enroll in Medicare, you get a signup period called “guaranteed issue rights.” This means you can enroll in a Medigap plan without medical underwriting.
Medical underwriting is the process of figuring out a person’s health insurance premium. It’s based on several factors, including their health. It also means that a healthcare insurer can deny coverage to people who don’t meet health standards.
Outside of your initial enrollment period, you’re not offered “guaranteed issue rights.” That means you’d be subject to medical underwriting. For people with pre-existing conditions, this means more expensive monthly premiums. Even denial of coverage.
Luckily, when you decide to try Medicare Advantage for the first time, you’re given trial rights. These give you time to decide if you like your new health insurance. If you don’t like your plan, you can switch back to Original Medicare and keep your guaranteed coverage.
Let’s explore that further.