| Dear Marci, I will turn 65 and enroll in Medicare soon. My friend who already has Medicare told me that I will need to choose between Original Medicare and Medicare Advantage. What are these options? -Noah (Seattle, WA) Dear Noah, Original Medicare is the traditional fee-for-services program offered directly through the federal government. It is sometimes called traditional Medicare or fee-for-service (FFS) Medicare. Unless you choose otherwise, you will have Original Medicare when you first enroll in Medicare. Under Original Medicare, the government pays directly for the health care services you receive. You can go to any doctor and hospital that takes Medicare, anywhere in the country. In Original Medicare: You go directly to the doctor or hospital when you need care. You do not need to get authorization from Medicare or a referral from your primary care doctor for most services. You are responsible for a monthly premium for Part B. Some people also pay a premium for Part A. You typically pay a coinsurance charge, or a percentage of the amount of Medicare’s approved payment amount, for each service you receive. There are limits on the amounts that doctors and hospitals can charge for your care. If you want prescription drug coverage with Original Medicare, in most cases you will need to actively choose and join a stand-alone Medicare private drug plan, also called a Part D plan. If you have Original Medicare, you may choose to purchase supplemental insurance to help pay out-of-pocket costs, commonly called a Medigap plan. Medicare Advantage Plans, also known as Medicare private health plans or Part C, are plans that contract with the federal government and are paid a fixed amount per person to provide Medicare benefits. Remember, you still have Medicare if you enroll in a Medicare Advantage plan. This means that you likely pay a monthly premium for Part B (and a Part A premium, if you have one). You may also need to pay a monthly premium to your Medicare Advantage plan in addition to your Part A and/or B premium. Medicare Advantage plans must cover all the same services as Original Medicare, and they usually include prescription drug coverage. In Medicare Advantage plans: You generally need to see providers who are in your plan’s network and service area to pay the lowest cost for services. In many plans, you must get prior authorization or a referral from your primary care provider for specialty services, procedures, and durable medical equipment. You will often pay fixed copayments per service or item you receive. These costs vary from plan to plan. Plans cannot charge higher copayments or coinsurances than Original Medicare for certain services, like chemotherapy and dialysis, but they can charge higher cost-sharing for other services. Your out-of-pocket expenses for Part A and B services are limited. For example, the maximum out-of-pocket cost for many plans in 2020 is $6,700. A plan may offer certain benefits that Medicare does not cover, such as dental and vision care, caregiver counseling and training, and certain in-home support like housekeeping. Not all plans cover additional benefits, so check with a plan directly to learn what benefits it covers. You cannot purchase a Medigap plan. They are only designed to work with Original Medicare. You can join a Medicare Advantage Plan if you have Medicare Parts A and B, you live in the plan’s service area, and you do not have End-Stage Renal Disease, except in limited circumstances. -Marci |