If you or your senior loved one are a bit confused by the differences between Medicare and Medicare Advantage, don’t despair. You are not alone. Many seniors are unsure of what advantages are offered by each plan and wonder how their choice may impact home health care.
We hope to clear up any confusion between the two choices and give you the information you need to make an informed decision. Medicare’s purpose is to ensure that seniors have access to affordable health care, but it is no longer a simple decision of whether to enroll in Medicare. Now you have the choice to enroll in Medicare Advantage. Here’s what you need to consider to choose the right plan:
How each plan is administered: Medicare is administered by the federal government, but Medicare Advantage is administered by private companies while being regulated by the federal government. The plans for Medicare Advantage are offered by health maintenance organizations (HMOs) or preferred provider organizations (PPOs) and must offer at least the level of coverage given by Medicare. It will often provide additional coverage, such as vision or dental care and prescription drug coverage. Medicare Advantage may offer lower copayments for services or it can provide a broader level of coverage.
Your decision isn’t final: Keep in mind that you have the opportunity to switch between Medicare and Medicare Advantage, or between two different Medicare Advantage plans every year. Open enrollment for Medicare and Medicare Advantage runs from October 15 to December 7 each year. However, those that would like to switch back to Medicare from Medicare Advantage need to enroll between January 1 and February 14. Initial enrollment is set for yet another timeframe, so be careful not to miss the correct dates to get the coverage you want.
Choose between cheaper premiums and peace of mind: The key difference between the two programs is often what you actually pay for medical care. While Medicare Part A and Part B covers many of your medical expenses, there is no spending limit on out-of-pocket expenses. Medicare covers 80 percent of the approved service, but you will need to come up with the rest, no matter how much it costs.
Medicare Advantage has a higher monthly payment when compared to the original Medicare option, but Medicare Advantage plans cap the out-of-pocket expenses. In 2015, the maximum out-of-pocket you will spend is $6,700. When choosing between Medicare and Medicare Advantage, the difference often boils down to choosing between lower premiums with Medicare and the assurance of a maximum medical bill with Medicare Advantage. Senior living often goes hand-in-hand with a fixed income, so for many enrollees, the maximum out-of-pocket expense can be attractive.
At Freudenthal Home Health, we offer guidance for your health care decisions, like choosing the best Medicare options. If you would like more information or need to ask questions, please call us for an appointment.