Aging into Medicare

By Marlene Baca

An important Medicare deadline is approaching for many New Mexicans. The Medicare Open Enrollment Period began Oct. 15, 2012, and will end on Dec. 7, 2012. During the Open Enrollment Period, you can switch from Original Medicare (Medicare Parts A & B) to a Medicare Advantage (Part C) plan, switch from a Medicare Advantage plan back to Original Medicare, switch from one Medicare Advantage plan to another and make changes to your Medicare Part D prescription drug plan. For additional information or questions regarding the Medicare Open Enrollment Period, please visit We are continuing in our monthly series about what it means to age into Medicare and what Medicare means for you. This month, we will explain the differences between Original Medicare and a Medicare Advantage plan, as well as the pros and cons between the two.

Original Medicare is the federal health insurance program that is for people age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant). A Medicare Advantage plan, or MA plan, is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A & B benefits. Medicare Advantage plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans.

What does Original Medicare include?

Original Medicare Part A benefits cover hospital services, inpatient care, temporary skilled-nursing facility visits and hospice. Part B covers physician and outpatient rehabilitation costs.  

What does a Medicare Advantage plan offer?

Medicare Advantage plans, such as Lovelace Medicare Plan, provide both Medicare parts A and B as well as providing emergency room and urgent care coverage. It is important to understand that every Medicare Advantage plan is different and can offer a variety of benefits. Some of those possible benefits can include vision, dental, hearing, preventative care, prescription coverage that isn’t dependent on Medicare Part D enrollment and health and wellness benefits. If you enroll in a Medicare Advantage plan, Medicare services are covered through the plan and aren’t paid for under Original Medicare.  

Understanding the differences between Original Medicare and a Medicare Advantage plan

While a Medicare Advantage plan offers additional benefits that Original Medicare does not offer, it is important to find the plan that is the best fit for you. Members that are enrolled in Original Medicare may receive care with any hospital or doctor, whereas members with a Medicare Advantage plan are limited to certain contracted providers. If you are seen by a particular specialist or at a certain facility for which you did not receive prior authorization from your Medicare Advantage plan, it is possible that you may incur out-of-pocket charges. Before enrolling in a Medicare Advantage plan, review the benefits and costs as well as the pros and cons of the plan to make certain it is the right decision for you.  

Marlene Baca is Lovelace Health Plan’s Chief Programs Officer. “Aging into Medicare” is a monthly series on Medicare topics. She is happy to take questions for future columns. Email

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