Medicare vs Medicare Advantage

When you reach the age for Medicare eligibility, there are many decisions you must make for your insurance choice. Chiefly, whether to sign up with Original Medicare or a Medicare Advantage Plan. But understanding their differences can be quite tricky. On the surface, they may seem like the same thing, but each has significant differences that make a difference to your care and finances.

The choice you make depends on several factors, including your location, your health needs, and your financial situation. Here’s a brief look at the differences and circumstances that may help you make your choice.

Original Medicare is health insurance offered through the federal government. This insurance is available for those 65 and older and some people with certain disabilities. Original Medicare consists of hospital coverage under Part A and Part B, which covers doctor visits, lab work, and medical equipment. There is also the option to enroll in a Part D prescription drug plan.

When you choose to enroll in Original Medicare, you will have a deductible, copays, and coinsurance , but you can visit any healthcare provider who accepts Medicare, usually without a referral or preapproval. You also have the option to enroll in a Medicare supplement plan that helps to cover out-of-pocket costs of your co-pays and coinsurance. This is especially helpful because Medicare has no spending cap for out-of-pocket expenses.

Medicare Advantage is Medicare offered through private insurance companies. This insurance operates much like private insurance you may have received through your employer. Typically, Medicare Advantage plans offer similar features to Original Medicare which includes Part A hospital coverage and Part B medical coverage in exchange for the monthly premium. This Part B premium must be paid whether you choose Original Medicare or a Medicare Advantage plan. Dental, vision and prescription drug coverage are often included.

Most types of Medicare Advantage Plans operate on a preferred provider organization system, meaning you can only visit healthcare providers who are in-network unless you’d like to pay out-of-pocket costs.

Original Medicare is an excellent choice for those who plan to spend retirement traveling. Because you can visit any healthcare provider that accepts Medicare, you are not required to see your home doctor. Additionally, if you get sick on the road, you can find a doctor nearby.

Medicare will not reject your coverage if you have pre-existing conditions. Though, if you intend to purchase a Medigap plan with a pre-existing condition, you must do so within the first six months of enrollment in Part B, or else you risk losing coverage for your condition. It is always an option to switch back and forth between Original Medicare and Medicare Advantage, but if you know you need a Medigap plan and have a pre-existing condition, you should choose Original Medicare.

If you fall ill or get a diagnosis requiring a significant amount of care, you could be on the hook to pay thousands out of pocket from co-pays and coinsurance. Therefore, it is wise to purchase a Medigap supplement plan when you sign up for Original Medicare. If your budget does not allow for this, you might should consider a Medicare Advantage plan.

Though you cannot see any doctor of your choosing, if you live in a city with a pretty broad network of providers who take your specific Medicare Advantage plan, you shouldn’t find an issue choosing a good doctor or specialist you would like to see. This is a common choice for those who live in larger cities or near medical facilities.

Similarly, since not all providers take all Medicare Advantage plans, it is best to only choose an Advantage plan if you know you will be in an area with available providers. Therefore, if you live in your forever home (or at least long-term) and have no plans to move any time soon, choosing a Medicare Advantage plan can work in your favor.

Are you looking for additional coverage, such as dental and vision? Then Medicare Advantage may be your best choice, as these additional coverage options are often included in most available plans. This ensures that all of your coverage comes from the same place rather than having to purchase private insurance or pay out of pocket for these services.

Understanding your Medicare options can be quite confusing. It can also be time-consuming to do the research yourself. Every person has different needs, and one plan may be better than another for your specific healthcare circumstances. Let us help you. Our team at Patriot Insurance Brokers is available to walk you through the options and steps of enrollment to ensure that you find the perfect plan for you as a Medicare beneficiary. Call us today to get started.