What is the Difference Between Medicare and Medicare Advantage?
Many seniors can’t afford to be without full health care coverage. It is important to understand how to choose the right Medicare options for your needs. You will read that the services covered by Medicare and Medicare Advantage are the same. But seniors like you are learning that this is often not the case. Many Medicare Advantage plans require you to wait for approval to see if they will pay for the care your physician recommends. Medicare Advantage plans also often delay or deny care that physicians deem necessary, leaving you unable to get the care you need. And if you continue with the care that’s been recommended, Medicare Advantage often refuses to pay for it.
You get what you pay for.
Medicare Advantage plans may promise to cover your monthly expenses or throw in extra services as part of your health care coverage. But many of our patients are finding that those extras come at a cost: not being able to access the care they need or not having it paid for when they need it. And it’s not just here. In 2021, 2 million prior authorization requests were denied for Medicare Advantage patients, further delaying care deemed medically necessary by their provider. While in some cases the monthly cost for Original Medicare is higher, it comes with the peace of mind that you will be able to get the care you need.
Be aware:
Medicare Advantage plans are increasingly removing providers from their networks. This means they are “out of network” with doctors, hospitals, and health systems, and you may need to switch doctors or face higher out-of-pocket costs if you choose Medicare Advantage. You can always receive care at the hospital and from the health care provider of your choice with Original Medicare.
Patient Story With Medicare Advantage
During his hip replacement, James* did not react well to the anesthesia and was admitted for a neurology review. Because of his Medicare Advantage plan, he had to wait at the hospital, unable to walk, while he waited for his insurer to approve his transfer to a rehabilitation center.
*Not patient’s real name
FAQs: How to Sign Up for Original Medicare and Medicare Advantage
For Original Medicare, you need Part A (hospital care, home health, and hospice) and Part B (doctor visits, labs, and outpatient services). You may also sign up for Part D (prescription drugs).
Part C is Medicare Advantage, obtained through private insurance.
Original Medicare and Medicare Advantage:
Annual enrollment is October 15 – December 7 or thereabouts each year. If you’re in a Medicare Advantage plan and want to switch to Original Medicare, you can use the Medicare Advantage annual enrollment period to make that switch.
The initial enrollment period is within the 3 months before you turn 65, including the month you turn 65, and ends 3 months after the month you turn 65 (7 months total). Some individuals under 65 are eligible with disability benefits from Social Security or the Railroad Retirement Board.
You can change plans as often as you’d like during this period.
Medicare Advantage Open Enrollment (Change Period)*
*Only if you’re already enrolled in a Medicare Advantage plan.
The plan change enrollment period is January 1 – March 31.
The initial enrollment period is within the 3 months before you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65 (7 months total). During the period of January 1 – March 31 each year, you can only change your selection once.
Original Medicare
If you are 65 and older, you can sign up for Medicare Parts A and B on the Social Security website (SSA.gov/Medicare-sign-up) or call the Social Security Office Monday – Friday, 8 am – 7 pm at 1-800-772-1213.
You can also call Medicare at 1-800-633-4227.
Medicare Advantage
You can enroll at Medicare.gov/plan-compare or call Medicare at 1-800-633-4227
Medigap supplemental plans require separate enrollment, which can sometimes take up to 30 days to take effect. Also note that if you leave a Medicare Advantage Plan, pre-existing conditions could impact the cost for your Medigap policy.
Visit medicare.gov/medigap-supplemental-insurance-plans to compare plans in your area.
To view a list of all Medicare Advantage plans accepted by St. Joseph Health, visit our website.
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