Confused about Medicare? Start here.
Posted 01/08/24
What is Original Medicare?
If you’re finding it challenging to navigate Medicare, you’re not alone. Our three-part series on understanding Medicare is designed to provide the facts and help people like you make informed choices about their health care coverage. In part one, we begin with an overview of Medicare and a look at your choices.
First, the basics
Medicare is the health insurance program provided by the U.S. government for people age 65 and up and people with disabilities. The Centers for Medicare and Medicaid (CMS) is the federal agency that administers the health plan called Medicare or “Original Medicare.” Medicare has different components or parts, which cover different things.
(You can also choose to purchase additional insurance, called a Medicare Supplement plan, to help cover some of health care costs not covered by Original Medicare. We’ll look at this option in detail in Part 2 of this series.)
It helps to start with the fact that you essentially have two choices for how you receive your Medicare coverage. One is through Original Medicare. The other is through Medicare Advantage.
(If you choose to be covered by Original Medicare, you can also buy additional coverage which “supplements” Original Medicare. We’ll look at this option in detail in Part 2 of this series. )
This can all seem very confusing. So, let’s start from the beginning to help clear up the facts.
What is Original Medicare?
Think of Original Medicare as your most basic option. Provided by the federal government and administered by the Centers for Medicare and Medicaid (CMS), it includes coverage for hospital visits (known as Part A) and coverage for visits to doctors and specialists (known as Part B). It doesn’t cover prescription medications, worldwide emergency care, dental care, or other health-related expenses like eyeglasses and contact lenses, hearing, and fitness.
Most people don’t have to pay a monthly cost or premium for Medicare Part A, but deductibles and coinsurances often apply. For Medicare Part B, most people pay a monthly premium, an annual deductible, and coinsurance —for certain services and equipment. For the most up-to-date information on costs and coverage, visit the Medicare.gov website or contact a Medicare expert.
With Original Medicare, you can get care from any provider or hospital that accepts Medicare.
What is Medicare Advantage?
The key thing to remember is this: Medicare Advantage plans cover everything Original Medicare covers, along with more benefits to help support your best health.
Medicare Advantage is provided by private health care companies that have been approved by CMS to offer Medicare coverage. Often called Part C, MA, or “all-in-one” plans, Medicare Advantage plans cover everything included in Medicare Parts A and B, plus extras like eye wear and dental benefits. Many Medicare Advantage plans also include prescription drug coverage (also known as Medicare Part D).
With a Medicare Advantage plan, you pay out-of-pocket costs directly to the doctor, care center, or hospital. CMS pays Medicare Advantage companies for providing Medicare benefits to its members.
The Medicare Advantage safety net
Along with extras that help keep health care dollars in your pocket, Medicare Advantage plans also come with a valuable buffer. They set copayment fees or coinsurance — a percentage of the overall cost — for the services they cover. Plus, there’s a limit on how much you’ll pay in a single year. If your plan’s limit is $6,500 and you spend $6,500 on covered health care before the end of the plan year, your plan picks up the costs for the rest of year for your Part A and B expenses (hospital and medical).
With Original Medicare, on the other hand, there’s no annual cap. That means the amount you pay in deductibles and cost-shares can keep climbing all year.
If you opt for Medicare Advantage, you choose a health care company like Martin’s Point, and a plan — a particular set of benefits and costs. Martin’s Point offers a range of Medicare Advantage plans called Generations Advantage that includes HMO, HMO-POS, and PPO options. This variety makes it easy to find a plan that fits your particular budget, health needs, and preferences.
Whichever plan you choose, your Medicare Advantage plan has to follow Medicare’s rules. Each Medicare Advantage company is approved and contracted by CMS, and paid to manage Medicare benefits.
Shopping around? Know what to look for.
With hundreds of Medicare Advantage plans to choose from, it’s important to know what you’re shopping for. Keep these key points in mind:
- Total cost. While Original Medicare requires you to meet deductibles, Martin’s Point Generations Advantage plans have no medical deductibles, which helps you control what you pay out of pocket. Sometimes your copay is as low as $0. In addition, Generations Advantage plans cap the amount you’ll ever pay in a single year, helping you plan and preventing worry.
- Choice. Different plans have different rules about which health care providers you can see, often requiring you to seek care from providers and facilities that are part of their network (in other words, on an approved list). Our Generations Advantage network is noted for a scope that gives members extensive in-network choice for the best value. Most of our plans also offer out-of-network benefits.
- Quality. Each year, Medicare rates all Medicare Advantage plans based on member feedback and information from plans and health care providers. Plans earn 1 to 5 stars, with 5 as the highest rating. Martin’s Point Generation Advantage plans are highly rated, consistently receiving top ratings for quality and service so you can choose them with confidence.
We’re here to help
Look for Part 2 in our Medicare series for a deep dive into the differences between Medicare Advantage plans and Medicare Supplement insurance.
To learn more about Generations Advantage Medicare Advantage plans from Martin’s Point right now, visit our 'Generations Advantage Plans Benefits' page or call 1-855-760-0983 (TTY: 711). There’s no time like the present!
