Medicare vs. Medicare Complete: Understanding the Key Differences

Medicare Complete plans offered under Medicare Advantage are run by private insurers as an alternative to original Medicare. Beneficiaries enrolled in Medicare Complete receive broader benefits in exchange for restrictions on provider selection.

Features

• Medicare beneficiaries choosing original Medicare premiums, deductibles and co-payments are set by federal law.

  Medicare Complete participants pay the Part B premium to Medicare and may pay an additional plan premium. The plans, however, usually impose lower co-payments and benefits may include dental, vision, preventive care and wellness services not covered by original Medicare.

Medicare Supplements (Medigap)

• If you enroll in a Medicare Complete plan, Medigap plans will not pay deductibles, co-payments or other cost sharing. Beneficiaries choosing Medicare Complete usually cancel their Medigap plans.

Restrictions

• Medicare Complete plans often require beneficiaries to coordinate care through a primary care physician, remain with in-network providers and receive care at specified hospitals. Original Medicare does not carry these limitations.

Plan Types

• Original Medicare is a fee-for-service program. Patients choose their providers and Medicare pays based on the services performed.

  Medicare Complete plans include private fee-for-service (PFFS) plans, health maintenance organizations (HMOs), preferred provider organizations (PPOs) and Special Needs Plans.

Part D and Supplemental Plans

• Many Medicare Complete plans include drug benefits. Individuals in these plans cannot opt out of drug coverage or choose another plan. Beneficiaries in plans without drug benefits, or in original Medicare, can choose a drug plan or opt out of coverage.