Original Medicare Vs. Medicare Advantage Plans
Medicare is a federal program designed to offer health coverage for the elderly and certain disabled individuals. Original Medicare (Part A and B) and Medicare Advantage Plans are two forms of health coverage offered under the Medicare program.
Identification
Original Medicare consists of Part A (hospital benefits) and Part B (outpatient medical benefits) and is offered by Medicare directly. Medicare Advantage Plans, offered by private insurance companies, provide hospital and medical benefits and also typically provide additional benefits not provided by original Medicare, such as prescription drug coverage.
Networks
Original Medicare allows you to see any medical provider that accepts Medicare and is taking new patients with Medicare benefits. Medicare Advantage Plans typically require you to access certain medical providers that are in-network, regardless of whether other medical providers that accept Medicare are available.
Services
Original Medicare does not cover the cost of prescription drugs, vision care or hearing care. Medicare Advantage Plans may cover vision, hearing and prescription drug costs not covered by Medicare.
Requirements
The same eligibility requirements must be met for enrollment in original Medicare or a Medicare Advantage Plan. These requirements include being 65 years or older, under age 65 with certain disabilities or having permanent kidney failure that requires dialysis or a kidney transplant (see reference 2).
Enrollment
Individuals under age 65 who have been collecting Social Security disability benefits for at least 2 years or individuals 65 years or older are automatically enrolled in original Medicare Part A and typically Part B as well. If you are not automatically enrolled in original Medicare (Part A and/or B), you can obtain enrollment information from your local Social Security Administration office. Enrolling in Medicare Advantage Plan requires having active Medicare Part A and B coverage, living in an area where a Medicare Advantage Plan is available and is completed by contacting the private insurance company offering the Medicare Advantage Plan.
Renal Failure
Original Medicare is automatically awarded to individuals who require a kidney transplant or dialysis. Medicare Advantage Plans do not enroll individuals with end-stage renal failure unless a successful transplant has already occurred or if the renal failure happens after enrollment in the plan.
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