Tag: MA

Original Medicare –

Original Medicare is managed by the federal government and provides Medicare eligible individuals with coverage for and access to doctors, hospitals, or other health care providers who accepts Medicare.

Original Medicare is basically –

• Part A benefits (which provides Inpatient/ Hospital coverage) +
  • Part B benefits (provides Outpatient/ Medical coverage)

• You go directly go to the doctor/hospital when you need, no prior authorization required.
• You are responsible for a monthly premium for Part B, and typically pay a coinsurance.
• You will be using the red, white, and blue Medicare card for your service.

Medicare Advantage (MA Plan)–

Part A + Part B + Additional Benefits

• Federal Government/ CMS allows private health insurance companies to provide Medicare benefits.
  • Medicare Advantage Plans must offer, at least the same benefits as Original Medicare (those covered under Parts A + B) but can do so with different rules, costs, and coverage restrictions.
  • You will not use the red, white, and blue card anymore, instead you will use the private plan membership card.

Prescription Drug Plan (PDP Plan) –

Prescription drug benefit (Part D) provides outpatient drug coverage. This part/plan never provided directly by the government (unlike Original Medicare), and only provided through private insurance companies, which have contracts with the federal govt.