ARTICLE: How Medicare Advantage Stacks Up Against ‘Original Medicare’

How Medicare Advantage Stacks Up Against ‘Original Medicare’

When making any important decision, it is always wise advice to take the time to weigh the pros and cons of all available options. Choosing your Medicare plan is no exception and  that means comparing Medicare Advantage with “Original Medicare”.

Medicare Advantage, or Medicare Part C, is an alternative to “Original Medicare”. The latter 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 Medicare Parts A and B. Medicare Advantage plans, at a minimum, have to offer everything that’s covered under “Original Medicare”. One of the main benefits under a Medicare Advantage plan is that you could obtain additional coverage on top of what’s offered under “Original Medicare”, such as dental and vision coverage. Further, Medicare Advantage plans in your area may be tailored to meet a specific health diagnosis or need.

Each Medicare Advantage plan also comes with a maximum out-of-pocket limit on how much you’ll 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.

Unlike “Original Medicare” coverage, when you work with a private insurance company you may also find other complications such as:

  • 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’s best for each individual senior and his or her respective health needs. It is critical for you to research the Medicare options available to you in your area so that you may choose the right plan for you based on your health needs. Do not wait to research your options on the Medicare website where you will find the Medicare tool that allows you to research plan benefits by zip code.

Medicare also allows for program enrollees to switch from “Original Medicare” to Medicare Advantage, or vice versa, every year during the Annual Open Enrollment Period from October 15th to December 7th.  We know this can be a confusing topic and encourage you to ask us your questions on this or any elder law issue. Regardless of which plan you choose, make sure to read the fine print and compare different benefits, costs, and restrictions of each plan in your geographic area.

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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.