You go directly to the doctor or hospital when you need care. You do not need to get prior permission/authorization from Medicare or your primary care doctor.
You are responsible for a monthly premium for Part B. Some also pay a premium for Part A.
You typically pay a coinsurance for each service you receive.
There are limits on the amounts that doctors and hospitals can charge for your care.
If you want prescription drug coverage with Original Medicare, in most cases you will need to actively choose and join a stand-alone Medicare private drug plan (PDP).
In Medicare Advantage:
Medicare Advantage Plans, also known as “MA Plans” or “Part C,” are offered by private, Medicare-approved companies. These plans include:
Preferred Provider Organizations (PPO)
Special Needs Plans (SNP)
Private Fee-for-Service Plans (PFFS)
Medicare Medical Savings Account Plans (MSA)
Health Maintenance Organizations (HMO)
By enrolling in a MA (Medicare Advantage) Plan, you ensure the Medicare services you receive are covered by your plan rather than by Original Medicare. Many plans offer coverage for prescription drugs as well.
Eligibility:
You’re 65 years old or older.
You are not 65 but have a qualifying disability or End-Stage Renal disease.
You or your spouse have worked for ten years for an employer covered by Medicare.
You’re a citizen or permanent United States resident.
Medicare Advantage Plan Breakdown:
Part A – Inpatient Hospital Care, Skilled Nursing Facility Care, Home Health Care, Hospice Care
Part B – Outpatient Hospital Care, Provider Services, Durable Medical Equipment, Home Health Services, Ambulance Services, Preventiveness Services, Therapy Services, Mental Services, and more…
Part C – Medicare Advantage – Combines Part A, Part B, and Part D.
