Choosing the Right Medicare Path: Original Medicare or Medicare Advantage

Aug 17, 2023

If you already have your Medicare Parts A and B, you have the option to choose a Medicare Advantage plan from private insurance companies. Many eligible beneficiaries are opting for this path, as enrollment in Medicare Advantage plans has more than doubled since 2007. The trend continues in 2023, with a wide selection of plans available.

But is Medicare Advantage the superior choice to Original Medicare? The answer relies on factors like your preference for flexibility, capped annual expenses, additional benefits (e.g., vision, hearing, and dental coverage), and travel frequency. There’s no one-size-fits-all answer, but consulting a licensed Medicare insurance agent can help you make a well-informed decision.

Original Medicare

Original Medicare, often referred to as “traditional Medicare,” comprises two key parts: Part A (hospital insurance) and Part B (medical insurance). As a fee-for-service program, it allows freedom in selecting healthcare providers without the need for referrals to consult specialists.

Part A caters to inpatient care at hospitals, skilled nursing facilities, hospice care, and limited home healthcare services. Most individuals qualify for premium-free Part A if their spouse paid sufficient Medicare taxes during employment. In 2023, the deductible for Part A is $1,600.

a licensed Medicare insurance agent explaining different Medicare options to seniors.

Part B, on the other hand, covers outpatient care, preventive services, medical supplies, and doctor services. It entails a monthly premium of $164.90 in 2023, along with a deductible of $226.

While both Parts A and B include coinsurance or copays after meeting the deductible, it’s essential to note that Original Medicare doesn’t provide coverage for most prescription drugs, dental care, vision care, or hearing aids. Moreover, there is no annual maximum out-of-pocket limit unless beneficiaries opt for a Medicare supplement plan (Medigap) to obtain such coverage.

Exploring Medicare Advantage Plans: Standout Features

Medicare Advantage, also known as “Part C,” presents an attractive alternative to receiving Original Medicare benefits, with a substantial number of 2023 plans (89%) incorporating Part D prescription drug coverage. Private insurance companies approved by Medicare administer these plans, which offer an array of additional benefits like dental care, vision care, and transportation services.

While the majority of plans include Part D coverage, some do not. In such cases, beneficiaries have the option to purchase a separate drug plan or select a Medicare Advantage plan that encompasses drug coverage. Additionally, almost all Medicare Advantage plans operate with a provider network, predominantly HMO (58%) or PPO (40%) options in 2023. For HMO, beneficiaries must utilize in-network providers, while PPO allows more flexibility with lower out-of-network costs.

While some plans may charge an extra monthly premium alongside Part B, many do not require any premium at all, and a few even contribute to the Part B premium. On the whole, Medicare Advantage plans tend to offer lower out-of-pocket expenses compared to Original Medicare. Additionally, as of 2023, all plans are mandated to cap annual out-of-pocket spending at $8,300, with several plans offering even lower maximum limits.

Simplify Your Medicare Journey with Licensed Medicare Agents

Choosing the best plan and enrolling in Medicare coverage becomes a breeze with a Medicare agent in Melville. Their expertise, personalized guidance, and paperwork assistance ensure a hassle-free insurance experience.

If you seek ease and confidence in making the right decision, consult licensed agents at The Modern Medicare Agency. Serving Melville and other surrounding areas, our highly qualified team will ensure you have the right Medicare plan.

Contact us now to learn more about our exceptional services.