As the leaves turn and fall settles in, so does an important season for thousands of Kansans: Medicare open enrollment. From Oct. 15 through Dec. 7, older adults and those with disabilities must decide whether to stay with Original Medicare or move to a Medicare Advantage plan. It’s a choice that can shape everything from which doctors they see to how much they pay, and for many, it can be downright confusing.
“The name is confusing, obviously,” said Cindy Samuelson of the Kansas Hospital Association (KHA).
“Original Medicare is the health plan that people are most familiar with. It’s managed by the federal government and includes Part A, which covers hospital insurance, and Part B, which is medical insurance for doctor visits and outpatient care.”
Samuelson is vice president of Member and Public Relations for the association
Medicare Advantage, sometimes called Part C, works differently.
For starters, it’s not Medicare. Nor is it under the umbrella of the federal government.
“It’s offered by private insurance companies,” Samuelson explained. “If you choose Medicare Advantage, you’re basically picking a new plan.”
Melanie Smith, a Senior Health Insurance Counseling for Kansas (SHICK) counselor for Allen County, said that difference can lead to local confusion about which plans are actually available.
“Medicare Advantage plans are based on the county,” Smith explained. “When we go to help someone find a plan, they always ask what county you’re in, because that determines which plans are available. Even if you go five counties away, your card might not be eligible there if the plan doesn’t cover that area.”
ORIGINAL MEDICARE generally covers hospital and medical services, but not dental, vision or hearing care. Beneficiaries can add Part D for prescription drug coverage and may also buy a Medigap policy to help cover copays and deductibles.
With Medicare Advantage, coverage is bundled.
“Those plans have to cover everything Medicare covers,” Samuelson said. “But they can also include extras like limited dental, vision, or hearing benefits, or even things like gym memberships or grocery cards.”
She cautioned, however, that those add-ons can vary widely.
“People think, ‘Oh, I’m going to get dental,’ but it might just be one cleaning or a small amount toward a filling,” she said. “It’s really important to look closely at what’s actually covered.”
ONE OF the biggest differences between the two plans is how patients access care.
“With Original Medicare, you can see almost any doctor in the U.S.,” Samuelson said. “Only about 1% of providers nationwide don’t accept it. You don’t need referrals, and your coverage follows you wherever you go.”
