Like, which is better? Original Medicare or Medicare Advantage?
The answer is the frustrating – it depends.
After my dad’s former employer stopped offering a retirement health plan, I helped my mom walk through the Medicare maze.
I discovered several pitfalls in Medicare options. I hope by sharing some of what I learned, it will help you (or your loved one) when you face the Medicare maze of madness.
But, first, my disclaimer.
I am not an attorney or health care provider and cannot provide legal or health care advice. The information provided is for your general background only, and is not intended to constitute legal, insurance or health care advice as to your specific circumstances. I recommend reviewing your options with a qualified insurance adviser.
Original Medicare or Medicare Advantage: You Decide
In the last post, you learned Medicare Advantage (Part C) are plans offered by private insurance. You have the option to choose between Original Medicare and Medicare Advantage.
First, I’ll do a recap of your choices. I’ll start by using the graphic from the previous post.
Original Medicare has two parts.
- Part A is your hospital insurance
- Part B is your medical insurance (doctors visits, lab tests, etc.)
Typically, you pay a premium for Part B. You also pay deductibles and coinsurance (usually 20% of covered Medicare charges after the deductible is satisfied).
Review Medicare.gov Part B Costs for more information. The premium and deductibles often change each year.
In the past, there was no coverage for prescriptions. Pretty big deal for seniors. Thankfully, that changed.
Currently, Part D offers coverage for prescriptions IF you join a Medicare-approved prescription drug plan. Typically, you pay a monthly premium and will have copayments (a flat dollar amount per prescription) that you pay out of your pocket (or pocketbook).
Medicare.gov Drug coverage (Part D) can point you in the right direction. However, I recommend reviewing your options with a trusted broker who understands Medicare. As a licensed broker myself, I admit my bias.
Medicare Supplement (Medigap) insurance
If you have had medical care, you know all too well how expensive care is.
- Part A hospital insurance does not cover all charges
- You may pay a deductible and/or other out-of-pocket expenses
- Part B also has out-of-pocket expenses
Private insurers stepped in to offer policies to cover the “gaps” in Medicare coverage. Illustrated below are some of the coverage features.
MedicareInteractive .org offers additional things to know about Medigap policies.
In the Part C (Medicare Advantage) post, you learned these plans can be similar to those you may have had with an employer (e.g, HMOs, PPOs). However, because they are Medicare plans, they must follow certain rules.
- Must cover the same services as Original Medicare except hospice services
- You still have the same Medicare rights
- Medicare imposes strict rules on the marketing of Medicare Advantage plans
Some Medicare Advantage plans include prescription drug coverage. With others, you may need to purchase separate coverage.
So Which One?
I know, took long enough to get here. And I left out a slew of “extenuating” circumstances. There is nothing simple about Original Medicare or Medicare Advantage.
There are consequences to your choice. It is not uncommon for someone enrolled in either of the programs to discover those consequences the hard way.
I created the following comparisons to help identify key factors you need for choosing between the two. I separated the images below by category so poor boomer eyes (like mine) can actually read the content.
NOTE: The enrollment under Original Medicare+Medigap refers to the Medigap portion of the coverage. See Medicare Basics for information about when you’re first eligible for Original Medicare.
NOTE: Be sure to check if your doctors are in Medicare Advantage networks. None of my mom’s doctors were in the few Medicare Advantage plans available where we live. For that reason, she stayed in Original Medicare and added a Medigap and Prescription Drug plan.
Was that exhausting or what? See why I recommend getting professional help for signing up? If you or a loved one are approaching age 65, don’t wait until the milestone is upon you. It could be a real drag on your birthday celebration.
In a nutshell, the following are a few of the major factors in choosing Original Medicare or Medicare Advantage.
- Are Medicare Advantage plans available in your area?
- Are your doctors in their provider networks? (Important-check EACH plan- don’t assume if they are in one, they’re in all)
- Do your doctors accept Medicare? (not all do)
- Beware of enrollment periods (if you miss them, you could face late enrollment penalties)
- Don’t forget about prescription drug plans (Original Medicare and some Medicare Advantage plans require you to purchase them separately)
Add up the costs. There are sites that help you estimate out-of-pocket expenses.
May the force be with you.
Notice of Disclaimer –Cathy Miller is not an attorney or health care provider and cannot provide legal or health care advice. The information provided is for your general background only, and is not intended to constitute legal or health care advice as to your specific circumstances. We recommend you review legislation with legal counsel and visit your physician for health care issues.