Choosing the right Medicare plan may seem like a daunting task for many. Nonetheless, with a clear understanding of the differences between the plans, you can enroll in one that best suits your needs.
The Pros and Cons of Medicare Vs. Medicare Advantage If You…
- Take prescription drugs
Original Medicare only covers prescription drugs if you’ve enrolled in a stand-alone Prescription Drug Plan (PDP). Meanwhile, Medicare Advantage, aka Part C, also covers prescription drugs (Part D) and limits what you need to pay from your own pocket.
- Want to limit your out-of-pocket health spending
While Original Medicare does not put any ceiling on a patient’s out-of-pocket expenses, Medicare Advantage does so due to legal requirements. Its current annual limit is $6,700. That means any costs that exceed this out-of-pocket limit will be paid for by the policy.
- Are seeking an alternative to enhance your Medicare coverage
A Medigap plan is designed to supplement Original Medicare and cover certain deductibles, coinsurance, and other items paid by the patient. Medicare Advantage may provide cost savings, so discuss this option with your insurer.
- Want an alternative to the 20 percent coinsurance
You can bypass the 20 percent coinsurance cost of an Original Medicare plan for various services by joining Medicare Advantage. The out-of-pocket maximum will help keep your costs under control.
- Want coverage for vision and dental
Even though Original Medicare doesn’t cover vision or dental plans, there are Medicare Advantage plans that do. You need to ask your insurer about the available options.
- Want an extensive choice in doctors and other medical providers
Original Medicare is accepted by more healthcare providers than Medicare Advantage, which is a plan offered by commercial companies with Medicare’s approval. Some of these options include Health Maintenance Organization (HMO) plans and Preferred Provider Organization (PPO) plans. With these plans, you can only see doctors in a specific network unless you don’t mind paying more.
- Want maximum flexibility while seeking medical specialists
You’ll need authorization from a primary care doctor to see a Medicare specialist under a Medicare Advantage plan. However, this authorization is unnecessary under an Original Medicare plan.
- Are still working and covered by your employer
Check with your human resources department to determine if you’re paying a premium for Medicare Advantage, as many plans typically have zero premium. The Social Security Administration can give you further details.
- Have employer-sponsored retiree health benefits that supplement Original Medicare
Again, talk with your human resources department to see what type of benefits you can get from Original Medicare before signing up. These benefits, however, won’t help under a Medicare Advantage plan.