Medicare FAQs

Understanding the differences between Original Medicare and Medicare Advantage is important to helping you choose the right coverage for your needs.

You’re probably aware that you may be eligible for certain medical benefits from the government when you turn 65. This program is known as “Original Medicare”.

Medicare Advantage (or Part C) was launched in 1995 when the federal government created a way for private health care companies to sell new plans under a strict regulatory framework that combines both Part A (Hospital) and Part B (Doctor) coverage in a single plan.

All Medicare Advantage plans offer at least the same benefits as Medicare Parts A and B. That means if Original Medicare covers hospital care at a certain level, so will every Medicare Advantage plan on the market.

But the benefit of Medicare Advantage plans is that they offer more coverage than Original Medicare, and many also include prescription drug coverage.

There are specific times when you can sign up for a Medicare Advantage Plan or make changes to coverage you already have.

Medicare Annual Enrollment Period

If you enroll in a plan that you feel is not meeting your needs, you may switch (or drop) your coverage during Medicare’s Annual Enrollment Period, which generally runs from October 15 — December 7 each year.

Special Enrollment Period

Your coverage will begin on January 1 of the following year. In most cases, you must stay enrolled for that calendar year, starting with the date your coverage begins. In certain situations, however, you may be able to join, switch or drop plans during a special enrollment period.

Medicare Advantage Open Enrollment Period

You can also make changes to your coverage during the Medicare Advantage Open Enrollment Period (MA OEP) which runs from January 1 — March 31 every year. Individuals may make only one election during the MA OEP.

Medicare Advantage plans offer all of the benefits of Original Medicare, and may include additional benefits such as coverage for dental, vision, hearing care and extra benefits like reimbursement for gym or yoga studio memberships, activity trackers, weight management programs, and more.

Medicare Advantage plans may also include prescription drug coverage so you don’t need to get a separate prescription drug plan.

Plus, there is a maximum limit to your out-of-pocket costs, so if you become sick and have a long hospital stay, there is a limit on the amount you will be required to pay. Original Medicare doesn’t provide a maximum limit.

Choosing Medicare Advantage will give you the coverage and support you need, all in one plan. Once you understand the differences, you can decide if a Medicare Advantage plan is the right choice for you.

Coinsurance is usually stated as a percentage, such as 20% of eligible expenses for outpatient surgery. This means the insurance plan would pay 80% of allowed covered charges and you would pay the remaining 20%.

A copay is a fixed dollar amount you would pay when you receive a covered service, such as a doctor’s office visit.

When you are enrolled in Original Medicare, you are free to use any doctor, hospital or other health care provider who accepts Original Medicare. This applies to Medicare Supplement plans as well. With a PPO (Preferred Provider Organization) or POS (Point of Service) plan, you have the freedom to use any Medicare provider — even one that is not in your network. However, you may have higher out-of-pocket expenses if you use a non-network provider.

With Original Medicare and Medicare Supplement coverage, you do not need to choose a Primary Care Physician (PCP). With Medicare Advantage coverage, it depends on the specific type of plan. With HMO (Health Maintenance Organization) plans, you must select a PCP who will coordinate all of your care.

No referrals required for in-network specialists.

With an HMO (Health Maintenance Organization) Medicare Advantage plan, a Primary Care Physician (PCP) guides and coordinates your health care and you must use in-network doctors, specialists and facilities when you seek care.

With a PPO (Preferred Provider Organization) Medicare Advantage plan, you’ll have lower out-of-pocket costs when you visit in-network doctors, specialists and facilities. Members are not required to choose a Primary Care Physician (PCP) and can visit any other licensed doctor, but pay higher out-of-pocket costs for that out-of-network care.

“Original Medicare” is what most people refer to as simply “Medicare”. The term Original Medicare came into use after Medicare Advantage plans were introduced as an alternative to traditional/original Medicare benefits offered through the federal government.

Original Medicare pays for many health care services and supplies, but it doesn’t cover all your costs. Most people need additional private coverage to help pay for out-of-pocket costs.

A Medicare Supplement plan is an optional plan to help offset out-of-pocket costs. Medicare Supplement plans are designed to work with Original Medicare to help pay costs that Original Medicare doesn’t cover. This coverage:

• Helps to pay Original Medicare’s deductibles and copayments.
• Gives you the freedom to choose your own Medicare-participating doctor — with no referrals needed for specialist care.
• Is “standardized” by the federal government — which means the benefits for each plan do not vary from one company to another. Price and service, however, may vary greatly from company to company.
• Does not cover prescription drugs.
• Braven Health does not currently offer Medicare Supplement plans. If you want to learn more about these types of plans, visit Medicare.HorizonBlue.com to learn about the plan options offered by Horizon Blue Cross Blue Shield of New Jersey.

Yes. If you’re under 65 and have been approved for Social Security disability benefits, you automatically get Medicare Part A and Part B. Your Medicare benefits will begin after you have received disability benefits from Social Security or, if applicable, certain disability benefits from the RRB (Railroad Retirement Board), for 24 months.

Original Medicare provides very limited coverage for prescription drugs, so most people find it helpful to have additional coverage. That’s why Medicare Part D was introduced. Medicare members now have the opportunity to get prescription drug coverage through a stand-alone Medicare Prescription Drug Plan (PDP), or as part of a Medicare Advantage plan that includes drug coverage (MAPD). All Braven Health Medicare Advantage Plans include prescription drug coverage.

Yes. You can register at Medicare.gov for convenient and secure access to your personal Medicare information. You can use the site to track your health care claims, check your Part B deductible status, get information on your prescription drug coverage, sign up to get your “Medicare & You”, handbook electronically; and much more.