One-stop-shop for Medicare is a key benefit of Medicare Advantage (Part C), an insurance for health that has several pieces of the federal program rolled into a single plan. That contrasts with Original Medicare (Parts A and B), which keeps the hospital and medical services separate.
The packaged aspect of Medicare Advantage consolidates health coverage by condensing inpatient care, outpatient services, and, in most plans, prescription drug coverage under one roof. It is a single-plan presentation that many find more convenient for a more integrated approach to their healthcare and benefits.
Original Medicare splits medical benefits into two broad categories: Part A, which includes inpatient hospital care, and Part B, which includes outpatient medical care. These two parts are separately covered for an individual with Original Medicare. Medicare Advantage plans are approved by the federal government but are administered by private insurance companies and must offer the same benefits as Medicare Parts A and B.
When you enroll in a Medicare Advantage plan, the plan is your main source for obtaining your Medicare-covered care. You don't lose Medicare, but rather a private company administers your benefits and your care.
Medicare Part A benefits are an integral part of any Medicare Advantage plan. This section of the coverage offers payment for inpatient hospital stay, skilled nursing facility stay, hospice care, and certain home health care. Under a Medicare Advantage plan, the private insurance company covers these services. Although the benefits are the same, the way you pay can vary.
You may have coinsurance or copayment for hospital stays, but these are controlled by the plan design that accumulates to an annual out-of-pocket maximum. This differs far more from Original Medicare, with no yearly out-of-pocket maximum.
Similar to Part A, Medicare Advantage programs are required to provide all services provided by Medicare Part B, including visits to doctors, outpatient services, durable medical equipment, and preventive services. How much you'll pay out-of-pocket for the care and which doctors and medical facilities you can see are determined by the plan's network of providers.
While Original Medicare enables you to see any physician who takes Medicare, a Medicare Advantage plan could limit you to seeing physicians in its network for optimal rates. The plan's cost-sharing structure, such as copays for visits to the doctor and coinsurance on other care, takes the place of Original Medicare's 20% coinsurance structure.
One of the most important features of the majority of Medicare Advantage plans is the fact that they actually do provide prescription drug coverage.
does not, but the majority of Medicare Advantage plans do as part of a packaged health and drug plan. That is one of the primary reasons that most individuals opt to select a Medicare Advantage plan over Original Medicare.
Medicare Part D, or drug coverage by prescription, is offered as a standalone, separate plan for individuals who have Original Medicare. Within the Medicare Advantage framework, this coverage will typically be part of the plan. Integrated plans like these are referred to as Medicare Advantage Prescription Drug plans (MA-PDs).
With an MA-PD, you have one card that will pay for both your medical and prescription drug benefits, and all of your costs are subject to the provisions of one plan. This simplifies navigating health care and drugs, from choosing a doctor to getting a prescription filled.
To get an overall picture of how these plans operate, individuals can read from resources such as this Centers for Medicare & Medicaid Services (CMS) fact sheet outlining the design and worth of these plans.