Understanding the key differences between Original Medicare and Medicare Advantage can help you decide which is better for your needs.
When it’s time to choose between Original Medicare and Medicare Advantage, it isn’t always easy to determine which is the better option for you and your healthcare needs. They both come with their own sets of pros and cons. Knowing their core differences and how each system works can help you decide which to choose.
Original Medicare
The main benefit of Original Medicare is that care is easy to access. Original Medicare allows you to see any physician or specialist that accepts Medicare without the need for a referral. According to the Kaiser Family Foundation, only 1% of doctors don’t accept Medicare. This means you should be able to access care with your current primary care physician and any specialists you see before switching to Medicare. It also means you’ll be able to receive medical care while traveling within the United States—this can be beneficial for seniors who have a vacation home or spend a lot of time traveling around the country.
For associated costs, the government sets the premiums, deductibles, and coinsurance amounts. However, there is no cap on out-of-pocket costs. Due to this, things can get expensive quickly if you need to receive an extensive amount of care. For most Original Medicare policyholders, a Medigap policy is also needed to help offset these costs.
Medigap
Medigap is often used by Original Medicare policyholders to offset the costs associated with their Medicare benefits. Medigap does not cover extra services, such as dental, vision, hearing, or prescription drugs.
Medicare Advantage
The main benefit of Medicare Advantage plans is that they can offer additional services that aren’t covered by Original Medicare. While Original Medicare and Medigap don’t cover other services, such as dental, vision, hearing, or prescription drugs, some Medicare Advantage plans will have these as options. They can even include wellness services such as gym memberships and coverage for over-the-counter medications.
Medicare Advantage plans have set copays for services, which often equates to lower out-of-pocket costs for your healthcare. They also have an annual cap on these out-of-pocket costs, which means you ultimately may spend a lot less on care each year.
Medicare Advantage plans come pre-bundled, known as a Summary of Benefits, so you get whatever is on offer with the plan you choose. For this reason, if you decide to get a Medicare Advantage plan, it’s important to make sure it has all of the coverage you need. Some Medicare Advantage plans require you to see in-network providers and have your care go through your primary care physician. When you need a specialist with a Medicare Advantage HMO plan, your PCP will be the one to make the referral and submit it to your insurance plan so that you can receive the necessary care. This can limit care in rural areas, and whenever you’re spending time away from your home since the plan’s network will be centered around your geographical area. Medicare Advantage plans vary based on zip code and carrier, so there are a variety of options.
Contact Aging Benefits Advisory Today!
If you need help navigating the world of senior health insurance, our advisors at Aging Benefits Advisory are here to assist. Take advantage of our free consultation to ensure that you receive the plan for your budget and needs. We specialize in Medicare Advantage, Medicare Supplements, Dental, Vision, and Final Expense insurance for the senior market of Pinellas County, Pasco County, Manatee County, Hillsborough County, Polk County, Sarasota County, Citrus County, and Marion County, Florida. If you would like a free consultation, contact us online or give us a call at 727-266-0355. For more information, follow us on Facebook, Pinterest, and YouTube.