When it comes to Medicare, one of the most important decisions you’ll make is choosing between Original Medicare and Medicare Advantage. Both options have their pros and cons, and it’s important to understand the differences between the two so you can make an informed decision. In this blog post, we’ll go over what Original Medicare and Medicare Advantage are, what each option covers, and the benefits and drawbacks of each.
What is Original Medicare?
Original Medicare is the traditional fee-for-service Medicare program. It’s made up of two parts: Part A and Part B.
Part A covers hospital services, including inpatient care, skilled nursing facility care, and hospice care. Part A is premium-free for most people, which means you won’t have to pay a monthly premium for this coverage.
Part B covers medical services, including doctor’s visits, laboratory tests, and medical equipment. Part B requires a monthly premium, which is based on your income. In 2023, most enrollees will pay $164.90 per month for Part B.
In addition to Parts A and B, you can also enroll in a Medicare Supplement plan, also known as Medigap. A Medicare Supplement plan can help cover the gaps in coverage that Original Medicare doesn’t cover, such as deductibles, copays, and coinsurance. Medigap plans are sold by private insurance companies, not through the government entity of Medicare.
What is Medicare Advantage?
Medicare Advantage, also known as Medicare Part C, is an alternative to Original Medicare. Instead of enrolling in Parts A and B and potentially a Medicare Supplement plan, you enroll in a Medicare Advantage plan, which combines Parts A and B and may also include additional benefits, such as prescription drug coverage.
Medicare Advantage plans are offered by private insurance companies and are required to provide at least the same level of coverage as Original Medicare. However, many Medicare Advantage plans offer more extensive coverage, including additional benefits such as routine dental and vision care, hearing aids, and wellness programs.
Benefits of Original Medicare
One of the main benefits of Original Medicare is that it provides a wide range of coverage options. With Original Medicare, you have the flexibility to choose your own doctors and hospitals, and you can also enroll in a Medicare Supplement plan to help cover the gaps in coverage.
Another benefit of Original Medicare is that it’s a government-administered program, which means it’s available in all states and has a standardized level of coverage. This makes it easier for people to understand what their coverage will look like, regardless of where they live.
Drawbacks of Original Medicare
One of the main drawbacks of Original Medicare is that it doesn’t cover everything. For example, Original Medicare doesn’t cover routine dental and vision care, hearing aids, or wellness programs. This means that if you want these additional benefits, you’ll need to enroll in a separate plan or pay for these services out of pocket.
Another drawback of Original Medicare is that it has higher out-of-pocket costs than Medicare Advantage. With Original Medicare, you’re responsible for paying deductibles, copays, and coinsurance, which can add up over time. There is no out-of-pocket maximum for Original Medicare without a Medigap plan.
Benefits of Medicare Advantage
One of the main benefits of Medicare Advantage is that it often offers more extensive coverage than Original Medicare. For example, many Medicare Advantage plans include prescription drug coverage, routine dental and vision care, hearing aids, and wellness programs.
Another benefit of Medicare Advantage is that it can have lower out-of-pocket costs than Original Medicare. With Medicare Advantage, your plan will cover many of the costs that Original Medicare doesn’t cover, such as deductibles, copays, and coinsurance.
Drawbacks of Medicare Advantage
One of the main drawbacks of Medicare Advantage is that it has more limited provider networks than Original Medicare. With Medicare Advantage, you may only be able to see certain doctors and hospitals that participate in your plan’s network. This means that if you want to see a doctor or specialist who is outside of your network, you may have to pay more out of pocket or switch plans.
Another drawback of Medicare Advantage is that it may have more restrictions on the services you can receive. For example, some Medicare Advantage plans may require prior authorization or have restrictions on the type of equipment or treatments you can receive.
Making the Right Choice for You
Ultimately, the choice between Original Medicare and Medicare Advantage will depend on your individual needs and preferences. If you’re looking for flexibility and a wider range of coverage options, Original Medicare with a Medigap plan may be the right choice for you. However, if you’re looking for a more comprehensive plan with lower out-of-pocket costs, Medicare Advantage may be the better option.
It’s important to remember that you can switch between Original Medicare and Medicare Advantage during the Annual Enrollment Period, which runs from October 15 to December 7 each year. If you’re unhappy with your current coverage, you can make changes to your plan during this time. However, there are restrictions around switching Medigap plans, depending on the state you reside.
In conclusion, both Original Medicare and Medicare Advantage have their own unique benefits and drawbacks. It’s important to consider your individual needs and preferences when making a decision between the two options. To make the best decision, it’s recommended to talk to a Medicare insurance advisor, compare different plans, and research the coverage and costs of each option.