What is Traditional Medicare Coverage?

September 07, 2024•4 min read

If you're nearing age 65 or helping a loved one navigate the complexities of health insurance, you may be wondering about traditional Medicare coverage. At Bourgeois Insurance Agency, LLC, located in Thibodaux, Louisiana, we are here to help you understand your options and make the best choice for your healthcare needs. Call us at (985) 803-8999.

Understanding Original Medicare

Original Medicare is a federal health insurance program that primarily caters to individuals aged 65 and older. It consists of two main parts:

Part A: Helps cover inpatient hospital stays, skilled nursing facilities, and, to some extent, home care.
Part B: Covers outpatient care, medical supplies, and preventive services.

These two parts form the cornerstone of traditional Medicare that most people refer to. While Original Medicare covers a substantial portion of healthcare needs, it does not pay for everything, leaving some out-of-pocket costs like coinsurance, deductibles, and premiums for specific services.

Exploring Medicare Advantage

Medicare Advantage, also known as Part C, is another way to get your Medicare coverage. Offered by private insurance companies approved by Medicare, these plans must provide at least the same benefits as Original Medicare, but they often include extra benefits like vision, dental, and even prescription drug coverage (Part D).

Medicare Advantage Plans can also offer lower out-of-pocket costs and have set annual limits on out-of-pocket expenses. However, you are generally required to use the plan's network of doctors and hospitals, which can limit your choices.

Comparing Original Medicare and Medicare Advantage

When deciding between Original Medicare and a Medicare Advantage Plan, it's essential to consider several factors:

Coverage: Original Medicare allows you to visit any doctor or hospital that accepts Medicare, while Medicare Advantage Plans usually have network restrictions.
Costs: Original Medicare typically requires you to pay separate premiums for Part A (if applicable), Part B, and prescription drug plans. Medicare Advantage Plans often bundle these costs, sometimes with lower premiums.
Extra Benefits: Medicare Advantage Plans often offer additional services like vision, dental, and prescription drug coverage that Original Medicare does not cover.

Parts of Medicare: A Comprehensive Guide

Understanding the different parts of Medicare can be confusing, but breaking them down can help you make an informed decision.

Part A: Covers inpatient hospital care, limited home care, and skilled nursing facility stays. Most people do not pay a premium for Part A if they or their spouse paid Medicare taxes while working.
Part B: Covers outpatient care, preventive services, medical supplies, and doctor visits. A monthly premium is associated with Part B.
Part C: Also known as Medicare Advantage, which bundles Parts A and B, and often includes additional benefits like prescription drug coverage.
Part D: Provides coverage for prescription drugs and helps lower the costs of medications.
Medigap: Medicare Supplement Insurance that helps fill in the "gaps" in Original Medicare coverage by covering certain out-of-pocket costs.

Things to Consider When Choosing Between Original Medicare and Medicare Advantage

Making a choice between Original Medicare and a Medicare Advantage Plan can be daunting. Here are factors to consider:

Healthcare Needs: If you have specific healthcare needs that require specialist visits, Original Medicare might offer more flexibility.
Financial Considerations: Evaluate the premiums, out-of-pocket costs, and supplemental coverage options available to you.
Additional Benefits: If you need extra services like vision, dental, or hearing, a Medicare Advantage Plan may be more beneficial.

Switching from Original Medicare to Medicare Advantage

If you currently have Original Medicare and are considering switching to a Medicare Advantage Plan, there are certain periods during which you can make the switch:

Initial Enrollment Period (IEP): When you first become eligible for Medicare.
Annual Enrollment Period (AEP): Every year from October 15 to December 7.
Medicare Advantage Open Enrollment Period: From January 1 to March 31, you can switch from one Medicare Advantage Plan to another or go back to Original Medicare.

Before making a switch, consult with our team at Bourgeois Insurance Agency, LLC to ensure that you choose the best plan that fits your healthcare needs and financial situation.