The Modern Medicare Agency Blog
Should you choose Original Medicare or Medicare Advantage?
To correctly choose your program, you first need to understand the differences between the two.
The first Medicare program is called Original Medicare (also called Traditional Medicare) and the second program is called Medicare Advantage (also called Medicare Part C).
The Federal government administers Original Medicare, and there are two parts to this program: Part A and Part B.
Under Original Medicare, you can get care from any doctor or hospital who accepts Original Medicare. Studies show that about 95 percent of US doctors accept Original Medicare.
Original Medicare generally does not include coverage for prescription drugs. However, it will cover medications that must be administered by a medical professional, such as chemotherapy and radiation.
If you want prescription drug coverage and you are enrolled in Original Medicare, you’ll need to purchase a separate stand-alone Medicare Part D Drug Plan.
Since Medicare only covers 80 percent of the cost of your services, you are responsible for the remaining 20 percent. With Original Medicare, there is no annual cap on your out-of-pocket expenses. However, this is where supplement insurance (also called Medigap) plans come in. Most people get a Medicare Supplement plan to cover some or all of the 20 percent costs that Medicare doesn’t cover.
One of the significant differences between Original Medicare and Medicare Advantage is that Medicare Advantage programs are administered by private insurance companies that are approved by Medicare to offer benefits.
This means that the insurance companies negotiate prices they will pay doctors for different services and determine which doctors and hospitals you can see.
Therefore, most Medicare Advantage plans work more like HMOs or PPOs.
Medicare Advantage plans must offer all the same coverage as Original Medicare, but the most significant difference is that they determine which doctors and hospitals you can or cannot see.
Advantage plans sometimes offer additional benefits to their members. For example, some Medicare Advantage plans include Medicare Part D prescription drug coverage, so you get all your Medicare benefits in one plan.
Additionally, many offer coverage for routine vision, dental, and hearing services that aren’t available under Original Medicare.
Medicare Advantage plans also have copayments, coinsurance and also max out-of-pocket limits. These out of pockets can be up to nearly $7k each year.
While these are the high-level differences in the programs, the one that fits you best depends on the doctors that you currently see or what to see in the future. The biggest mistake people make is picking a plan with perks like zero premiums and gym memberships, then later realize their selected Medicare program won't cover treatment at their preferred doctor.
Also, because of insurability rules with Medicare, it can be hard, if not impossible, to switch programs later on. For this reason, it is incredibly vital you pick the right program for you when you first join Medicare.
Again, the program that is right for you depends on many factors including the doctors you currently see or want to see in the future, your health concerns, your medications, where you live, and how much risk you want to take.
If you would like some help deciding which coverage is right for you call my office at 631-805-5573
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