Navigating Medicare options can be confusing when you reach age 65. You have to decide between sticking with traditional, government-run Original Medicare or opting for a private Medicare Advantage Plan. There are pros and cons to both approaches. This guide examines the key differences to help you choose what works best for your needs.
What Exactly is Original or Traditional Medicare?
Under Original Medicare, the federal government directly pays healthcare providers for services rendered to beneficiaries. It consists of Part A, which covers hospital care, and Part B, which covers doctor visits and outpatient services.
Most people don’t pay a premium for Part A. Part B has a standard premium of $170.10 per month in 2023, but may be higher based on your income. Original Medicare covers about 80% of your costs on average after you meet the deductible. You can add supplemental coverage through a Medigap policy or employee/retiree coverage to cover gaps.
How is Medicare Advantage Plan Different?
Medicare Advantage Plans are offered by private insurance companies and bundle Parts A, B, and usually D together in one plan. Some differences include:
- Set provider networks – you generally pay more for out-of-network care
- Extra benefits like dental, vision, hearing
- More costs like copays and deductibles
- Maximum annual out-of-pocket spending limits
- Integrated Part D prescription drug coverage
You still get the same Medicare benefits, but how they are delivered differs.
Key Considerations: Original Medicare and Medicare Advantage
When deciding which type of Medicare coverage is right for you, some key factors to think about include:
Freedom to choose providers – Original Medicare gives you freedom to see any doctor accepting Medicare nationwide. Medicare Advantage Plans have networks.
Costs – Your out-of-pocket costs may be lower with Medicare Advantage, but you give up flexibility. With Original Medicare, you pay 20% coinsurance for most services.
Prescription drugs – Most Advantage Plans include Part D coverage. With Original Medicare, you need to enroll in a separate prescription plan.
Travel coverage – Original Medicare gives you coverage for medically necessary care nationwide. Medicare Advantage Plans often limit you to emergency care outside your service area.
Additional benefits – Many Medicare Advantage Plans include dental, vision, hearing, fitness, and other perks Original Medicare doesn’t offer.
Convenience – Medicare Advantage bundles all your coverage together in one plan. With Original Medicare, you may need to juggle multiple policies.
Making the Best Choice for Your Situation
There are good reasons some Medicare beneficiaries choose to stick with Original Medicare while others opt for the advantages of Medicare Advantage Plans. Think about your budget, health needs, provider preferences, prescription drug use, travel habits, and desire for extra benefits as you weigh options.
Speak with an insurance agent or your State Health Insurance Assistance Program if you need help deciding. You can switch between Medicare Plans each year during open enrollment if you find your initial choice isn’t the best fit long term. Both paths can provide solid Medicare coverage – identifying the right one for you is key.
We’re Here to Help
You do not have to spend hours reading articles on the internet to get answers to your Medicare questions. Give Scott Sims at Sims Insurance Medicare Plans a Call at (541) 915-0939. You will get the answers you seek in a matter of minutes, with no pressure and no sales pitch. We are truly here to help.
FAQs
Why do some people choose Original Medicare over Medicare Advantage?
Some people choose Original Medicare over Medicare Advantage because they prefer the freedom to visit any doctor or specialist who accepts Medicare, without needing a referral. Original Medicare allows you to choose any provider enrolled in Medicare that accepts Medicare assignment.
What is the difference between Original Medicare and Medicare Advantage?
The main difference between Original Medicare and Medicare Advantage is that Original Medicare is the traditional fee-for-service program offered directly by the federal government, while Medicare Advantage Plans are offered by private insurance companies approved by Medicare. With Original Medicare, you have separate coverage for hospital stays (Part A) and medical services (Part B), while Medicare Advantage Plans usually include all your Part A and Part B benefits in one plan. Medicare Advantage Plans may also offer additional benefits, such as prescription drug coverage (Part D) or dental and vision benefits.
Can I have a drug plan with Original Medicare?
Yes, you can have a separate stand-alone Medicare Part D prescription drug plan if you have Original Medicare. These plans are offered by private insurance companies approved by Medicare and help cover the cost of prescription medications.
Can I switch from Original Medicare to Medicare Advantage?
Yes, you can switch from Original Medicare to a Medicare Advantage Plan during the Medicare Annual Enrollment Period, which takes place from October 15th to December 7th each year. However, it’s important to carefully review the benefits, costs, and network of providers of each plan before making a decision.
Can I switch from Medicare Advantage to Original Medicare?
Yes, you can switch from a Medicare Advantage Plan back to Original Medicare during the Medicare Advantage Disenrollment Period, which takes place from January 1st to February 14th each year. You can also make this change during the Medicare Annual Enrollment Period.
What are the differences between Original Medicare and a Medicare Advantage Plan?
The differences between Original Medicare and a Medicare Advantage Plan include the way they are administered, their costs, and their coverage. Original Medicare is administered by the federal government, while Medicare Advantage Plans are offered by private insurance companies.
Original Medicare has separate costs for deductibles, copayments, and coinsurance, while Medicare Advantage Plans may have different cost-sharing structures. In terms of coverage, Original Medicare covers hospital stays (Part A) and medical services (Part B), while Medicare Advantage Plans usually provide all-in-one coverage for Parts A and B, and may include additional benefits such as prescription drug coverage.
Can I have both Original Medicare and a Medicare Advantage Plan?
No, you cannot have both Original Medicare and a Medicare Advantage Plan at the same time. If you choose to enroll in a Medicare Advantage Plan, you will be disenrolled from Original Medicare and receive your Medicare benefits through the Medicare Advantage Plan.
Can I have Medicare Supplement insurance if I choose a Medicare Advantage Plan?
No, you cannot have Medicare Supplement insurance, also known as Medigap, if you have a Medicare Advantage Plan. Medigap policies only work with Original Medicare, not with Medicare Advantage Plans.
What are the advantages of choosing a Medicare Advantage Plan?
Medicare Advantage Plans offer several advantages, including potentially lower out-of-pocket costs than Original Medicare, additional benefits beyond what is covered by Original Medicare (such as prescription drug coverage or dental and vision benefits), and coordinated care through a network of providers.
Can I compare Original Medicare and Medicare Advantage Plans?
Yes, you can compare the costs, benefits, and network of providers of Original Medicare and Medicare Advantage Plans using the Medicare Plan Finder tool on the official website of the Centers for Medicare & Medicaid Services (CMS).
