ARTICLE: How Medicare Advantage Stacks Up Against Original Medicare

How Medicare Advantage Stacks Up Against Original Medicare

When making any important decision, it is wise to weigh the pros and cons of all available options. For Medicare, that means comparing Medicare Advantage with “Original Medicare”.
Medicare Advantage, or Medicare Part C, is an alternative to Original Medicare, which is the traditional hospital and medical services coverage offered by the government health insurance program when it was created in 1965. Put simply, approved Medicare Advantage plans are provided by private insurance companies, and Medicare pays those private insurers a fixed amount every month to cover an enrollee’s costs.

That said, Medicare Advantage participants still must enroll in Original Medicare, or Parts A and B, and Advantage plans at a minimum must offer everything that is covered under Original Medicare. The main upside is that you could obtain additional coverage on top of what is offered under Original Medicare, such as dental and vision coverage, among other items.

Each Advantage plan also comes with a maximum out-of-pocket limit on how much you will spend on health costs each year. Once that limit is reached, enrollees will pay no additional costs for covered services.

Keep in mind, however, that Medicare Advantage plans can come in many different types, and different plans have different coverage limits that are subject to change every year. Benefits also vary by plan, as do premium costs and copayments.

These are all side-effects of obtaining Medicare health coverage through a private insurance company, unlike Original Medicare coverage.

Other complications include:

  • Strict rules for obtaining coverage for certain medical services and health products, like getting referrals to see a specialist.
  • Potentially changing your doctor or hospital to adapt to a Medicare Advantage plan’s network of approved coverage, or face higher costs.
  • Annual health insurer contracts with Medicare may change year to year, and even be cancelled.

Taken together, these pro and con considerations should help determine what is best for each individual senior and his or her respective health needs.

Medicare also allows for program enrollees to switch from Original Medicare to Medicare Advantage, or vice versa, every year during the Medicare Annual Open Enrollment Period.

If you are interested in a Medicare Advantage plan, make sure to read the fine print and compare different benefits, costs and restrictions with what would be available under Original Medicare in your geographic area. Your healthcare is an important part of your estate planning and elder law planning needs, we encourage you to contact our practice to get the advice you need for yourself and your loved ones.

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We at Roth Elder Law, PLLC, believe in providing services in a way that clients can easily understand and meaningfully participate in designing and maintaining their estate plan for their loved ones, as well as be assured that their plan will be administered according to their wishes.