I am writing today to inform the public in regards to Medicare and Medicare Advantage plans. There are many adults that have Medicare and Medicare Advantage plans, but I am going to let you know that they are not the same.

Medicare is the traditional program that is directly administered through the federal government. Medicare Advantage is sold by private insurance companies that provide Medicare benefits. The Medicare Advantage plan is like having an insurance plan that you, the individual that carries this plan must pay. You will pay your Medicare premium and your plan’s premiums plus any deductibles and copays and you CAN NOT buy a Medigap policy to help pay your out-of-pocket cost. You have an annual out-of-pocket limit, which can be high and the plan pays the full cost of your care after you reach that limit. Most plans do include a Part D drug coverage, whereas with original Medicare you can buy a separate Part D plan to cover your drug coverage.

You may be covered by some services that Traditional Medicare does not cover such as routine vision, hearing and dental care. But, all plans including Traditional Medicare must cover the same inpatient and outpatient services. If you need a referral to see a specialist; with Traditional Medicare you do not need a referral but with Medicare Advantage you often need a referral from your Primary Care Physician if you want or need to see a specialist.

I am going to give an example between the difference with Traditional Medicare and Medicare Advantage plans and Home Health Services. If an individual needs Home Health Services and has Traditional Medicare, Home Health only accepts what Medicare pays. In other words, is that an individual will not be billed for any remainder of their bill that Traditional Medicare does not pay. But with Medicare Advantage plans, sometimes in the plan there can be stipulations in having Home Health Services in which the individual is subjected to paying a percentage of the care provided. Also, the individual can be liable for a portion of their bill or the entire bill if the insurance company that supplies the Medicare Advantage benefits denies paying for the services that were or are rendered.

So, when it is time to look at your Medicare benefits and the time of year that you can apply changes to these benefits, please consider your options. The individuals that qualify for Medicare have worked many years and have paid into this through the Federal Government, why would an individual want to pay extra premiums for something that you already have paid for and possibly be denied benefits that you need or must pay additionally for?

If you would like a handout on the differences between Traditional Medicare and Medicare Advantage plans comparison, please stop by the Scotland County Home Health to get a copy.

Thank you,

Lynette Vassholz RN, Scotland County Health Department.