Difference Between Medicare and Medicare Advantage

Ever since the health insurance policies were introduced, people have shown a keen interest in them.

This is so because that it covers the expenses of the hospital, medicines, check-ups, and many other small entities under it.

The person having such insurance policies do not require to face inconvenience during the treatment as the payment is directly cleared from the respective company.

Medicare vs Medicare Advantage 

The main difference between Medicare and Medicare Advantage is that the individual having Medicare plan must not worry about their treatment and may go for a check-up to any doctor or specialist but with the condition of having an enrolled clinic that accepts Medicare while comparatively, on the other side, the individual having Medicare Advantage can only visit the doctors or clinics that have tie-up with the company.

Medicare vs Medicare Advantage

Medicare is a plan that is offered by the federal government of the United States to their people.

The government has made a cost ratio of 80-20, which means that 80% of the treatment cost will be covered under the plan while the rest 20% will be paid by the individual.

As the plan mainly includes all the hospital and medicine bills, it is quite a good choice for the person.

Medicare Advantage is a plan that is offered by the different private companies to the people. They have a varied number of plans and coverage plans according to the budget of the people.

The cost covered during the treatment completely depends on the plan or coverage purchased by the respective person.

Comparison Table Between Medicare and Medicare Advantage

Parameters of ComparisonMedicareMedicare Advantage
CoverageIncludes complete hospital bill and medical billIncludes hospital bill, medical bill, and the additive benefits
Drug CoverageDo not include in the planInclude in the plan
Additional benefitsAbsentPresent like – eye check-up, hearing, dental, fitness, etc
Offered By GovernmentPrivate companies
Referrals Not requiredSometimes it must be required
Out-of-pocket LimitNoYes but with the annual limit
ProviderAnyplace that is enrolled for accepting MedicareOnly places where the respective company has their tie-up with
CostA ratio of 80/20Depends on the plan purchased by the company

What is Medicare?

Medicare is a plan that is offered by the Government of the United States of America to its citizens. The plan is available to every person who has citizenship in the United States of America.

The Medicare policy includes two plans – A and B. In the plan, A series all the nursing facility, in-patient, home health, etc., treatment is covered, while in the plan B series, all the medical equipment, outpatient facility, home treatment, etc.

The cost of the plan is distributed in a ratio of 80:20 where 80% of the total expense of the treatment is covered by the Government while the rest of the 20% of the expense is to be covered by the individual.

The out-of-pocket limit is absent.

The policy does not include the cost of drugs within it. Also, any additional benefits are absent in the policy. The person having Medicare policy does not require to have a referral from the doctor.

They just have to visit a clinic, hospital, or medical facility where Medicare is accepted.

What is Medicare Advantage?

Medicare Advantage is a plan that is offered by various private companies to the citizens.

After purchasing the policy, the complete management of it is under the company, and the Government doesn’t have any role to play in it. Buying a private Medicare healthcare policy is a complete decision of the individual.

The Medicare Advantage includes all the facilities of Plan A and Plan along with the additional benefits. These additional benefits of the Medicare Advantage include – eye check-ups, hearing, dental, fitness, etc. The cost of the policy is in such a way that the individual has to pay according to their respective policy and plan.

The policy also includes drug coverage, and to avail of the benefit of the Medicare Advantage, the person has to go to the clinic, hospital, or medical facility that has the tie-up with their respective policy company; otherwise, it won’t release funds. 

Main Differences Between Medicare and Medicare Advantage

  1. The Medicare facility includes all the payments to be done in the hospital and the medicine purchased bill, whereas comparatively, on the other hand, the Medicare Advantage includes all the payments done against the hospital bill, the medical bill, and the additional tests covered during the treatment.
  2. The drug coverage in the Medicare plan is absent, whereas comparatively, on the other hand, the drug coverage in the Medicare advantage plan is present and is included within the charges.
  3. The additional benefits offered in the Medicare plan are nothing while comparatively, on the other hand, the additional benefits offered on the Medicare Advantage plan include many benefits within it, and they are – vision, hearing, fitness, dental, and many others.
  4. The Medicare facility is offered by the Government to their people while comparatively, on the other hand, the Medicare Advantage is offered by the private companies and varies upon different plans and coverage.
  5. The doctor’s referrals are not required in the Medicare plan for any treatment wheres comparatively. On the other hand, in the Medicare Advantage plan, most of the time, the doctor referrals are counted for the treatment.
  6. In the Medicare plan, there is no out-of-pocket limit, while comparatively, on the other hand, in the Medicare Advantage plan, the out-of-pocket limit is based annually.
  7. To avail of the Medicare plan, one may visit any clinic or hospital or medical facility, but the only point to be noted is that it must be enrolled and accepts Medicare plan while comparatively, on the other hand, the Medicare Advantage can be avail only where the company has its tie-ups with.
  8. The cost of the Medicare plan is based on an 80-20 ratio where 80% payment is made through the plan, and the rest is done by the individual while comparatively, on the other hand, the cost of Medicare Advantage depends on the different plans and coverage burrowed by the person.
Difference Between Medicare and Medicare Advantage

Conclusion

To summarize the given topic, this can be concluded that it is quite necessary for a person to have health insurance of their own and for the family.

This is so because the sudden hefty payments of hospitals, medical bills, varied health check-ups are directly carried away and can be claimed through the company.

With the surrounding scenario where disease and treatments are just getting increased, it is a very essential requirement.

Although the different plans of Medicare and Medicare Advantage include different coverage, prospects, or cost, etc. but are equally a source of benefit for the person.

According to the needs and required the person can borrow the policies and pay the premium on a yearly or monthly basis.

The Medicare plan is offered by the Government, while the Medicare Advantage is offered by the different private companies.

All in all, the documents and policies must be thoroughly checked and read before finalizing it.

References

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6907897/
  2. https://link.springer.com/article/10.1007/s11606-020-05826-x
  3. https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2018.0147
  4. https://jamanetwork.com/journals/jamanetworkopen/article-abstract/2777601
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