Q. What is the difference between Medicare and Medicare Advantage?
A: Medicare refers to original Medicare. This type of Medicare is run by the government, and you pay for each visit you have with a doctor. There is no network, so doctor choice is up to you.
Medicare advantage (MA) is a choice offered to replace original Medicare. MA is run by insurance companies who offer multiple plans to choose from. These plans will usually offer coverage for things like vision, hearing, dental and more, most of which original Medicare does not cover. Your out-of-pocket co-pay can range from zero to a few dollars a month, and most include Medicare D, or pharmacy coverage. Most of these plans have networks of doctors that you must use unless it’s an urgent or emergency. Some plans do allow you to go out of network, usually with a higher co-pay.
Q: What do Medicare Part A and B cover?
A: Medicare Part A covers inpatient hospitalization and includes skilled inpatient nursing.
Medicare Part B covers outpatient medical treatment like primary and specialty care visits, testing, outpatient therapy, durable medical equipment, and other outpatient services.
Q: Do either Part A or B cover prescription coverage?
A: No, neither Medicare Parts A or B cover prescriptions. However, Medicare Part D is responsible for the prescription drug coverage. While not covered by Parts A and B of original Medicare, many Medicare Advantage plans do include prescription drug coverage.
Q: I have a vision problem; will Medicare cover my eye doctor?
A: If you’re nearsighted or farsighted, original Medicare will typically not cover regular eye exams, frames, or lenses. However, many Medicare Advantage plans will.
Q: I feel overwhelmed by the Medicare process, who can help me?
A: If you’re feeling overwhelmed, your best bet is to call a reputable Medicare Broker or Agent. A broker may offer you more relevant information. There are also a number of resources available to you, among them are medicare.gov, the Office of the Aging, and several other online sites.
Q: What are Medicare supplements, and how can they benefit me?
A: Medicare supplements help in paying the costs that original Medicare doesn’t cover at 100%. There’s a variety of these programs available, and they can help transfer the financial risk of utilizing medical services to an insurance company.
Q: I understand that there are Medicare brokers and agents, are they the same thing?
A: No, they are in fact different. Medicare brokers have experience with multiple insurance carriers. These carriers offer a breadth of plans, which allows the broker to find one to fit your specific needs.
Medicare agents generally represent a specific company and market only products offered by that insurance organization.