Original Medicare or Medicare Advantage Plan? Consider These First Before Choosing
If you are a Medicare user, you would either have the choice of Original Medicare and Medicare Advantage Plan for your health coverage. But, how do you know what’s right for you?
Sixteen years dealing with just about any insurance plan in Michigan at American Insurance Advisors has taught me that when it comes to insurance plans, having as much information as possible so you can compare them accurately is the key to determining what is most appropriate for your needs.
This said, here are the provisions of the two types of Medicare:
Original Medicare is the federal government’s solo program offering:
Part A or inpatient/hospital coverage and Part B or outpatient/medical coverage
Limitations with how you, as a patient, can be charged regardless if your healthcare provider is ‘participating’ (accepts Medicare and always takes assignments) or ‘non-participating’ (accepts Medicare and may take assignments on a case-by-case basis).
Medicare Advantage Plan is a private plan that is contracted with the government to offer Medicare benefits. It offers:
The same benefits from Original Medicare but with varying costs and other limitations
Unique benefits that Original Medicate does not offer
A membership card from their plan when receiving care, the most common of which are Private Fee-For-Service (PFFS), Health Maintenance Organizations (HMOs), and Preferred Provider Organizations (PPOs) plans
Knowing all these are not enough, however, you must know how they are compared so you can form an accurate picture in your mind. Look for the following factors when comparing the two:
- Original Medicare – Your costs are fixed to cover Part A and Part B plus a monthly Part B premium
- Medicare Advantage – Your costs depend on your plan
- Supplemental insurance
- Original Medicare – You can purchase a Medigap policy
- Medicare Advantage – You cannot pay for a Medigap policy
- Provider access
- Original Medicare – You can hire the services of any provider that accept Medicare
- Medicare Advantage – Usually can only hire in-network providers
- Original Medicare – No need for referrals
- Medicare Advantage – Referrals are needed when you need to see a specialist
- Drug coverage
- Original Medicare – You are required to purchase a prescription drug plan
- Medicare Advantage – Your drug coverage will usually come with your plan although you would need to pay a higher premium
- Other benefits
- Original Medicare – No coverage for dental services as well as vision and/or hearing needs
- Medicare Advantage – Can cover additional services but will usually require a higher premium
- Out-of-pocket limit
- Original Medicare – Not applicable
- Medicare Advantage – You must shell out your personal savings yearly
The above information is generalized and may not necessarily apply to your area. Know the plans available to you by calling your State Health Insurance Assistance Program (SHIP) or calling Medicare directly. You may also speak with your local health and life insurance provider.
Interested in getting a plan? I can help you! I’m an insurance advisor in Troy, Michigan offering quality health and life insurance products for over 16 years and unparalleled industry expertise you can trust.