When you turn 65, you become eligible for Medicare, the federal health insurance program for people age 65 and older. Medicare offers two main types of coverage: Original Medicare and Medicare Advantage.
Original Medicare is a fee-for-service program that provides basic hospital, medical, and prescription drug coverage. You pay a monthly premium for Part B medical insurance, and you may also have to pay a deductible and coinsurance for covered services.
What’s the Difference between Medicare Originally Medicare Advantage?
In the other hand, Medicare Advantage is a private health insurance plan that offers all the benefits of Original Medicare, plus additional benefits like prescription drug coverage, dental, vision, and hearing coverage. Medicare Advantage plans are offered by private insurance companies, and they must follow the rules set by Medicare.
Choosing the right Medicare coverage depends on your individual needs and preferences. Original Medicare provides a comprehensive range of benefits, including Part A for hospital insurance covering inpatient hospital care, skilled nursing care, and home health care, and Part B for medical insurance covering doctor visits, preventive care, outpatient care, and various medical services.
Prescription drug coverage, known as Part D, is available either as a stand-alone plan or as part of a Medicare Advantage plan. Original Medicare offers maximum flexibility, allowing you to seek care from any doctor or hospital that accepts Medicare, regardless of network affiliation.
Now, this is not quite cheap. Note that Original Medicare can be associated with higher costs. Part B requires a monthly premium, and you may also be responsible for a deductible and coinsurance for the covered services. Consider these factors carefully when determining the most suitable Medicare coverage for your healthcare needs.
Disadvantage of the Medicare Advantage Plans
There are also drawbacks of enrolling in a Medicare Advantage plan. Unlike Original Medicare, which allows you to visit any doctor or hospital that accepts Medicare, most MA plans restrict you to their network of providers. This could mean limited access to your preferred doctor or specialists, especially if you live in a rural area.
Some MA plans require prior authorization for certain services, such as surgeries or specialist visits. This means you have to get approval from the plan before receiving the service, which can be inconvenient and delay necessary care.
Then you have higher out-of-pocket costs for out-of-network care. If you see a doctor or specialist outside the MA plan’s network, you will likely face significantly higher out-of-pocket costs. This can quickly become a financial burden, especially for unexpected or ongoing needs.
There are also potential high costs linked to the MA plans. This could mean facing unexpected changes in your coverage or cost, while the provider is free to change their networks, premiums and covered service annually.
Restrictions on Medigap Plans
If you choose an MA plan, you cannot purchase a Medigap plan to cover your out-of-pocket costs. This removes the flexibility and additional coverage options offered by Medigap plans.
Compared to Original Medicare’s freedom of choice, MA plans may feel more restrictive. You may have less control over your healthcare decisions and treatment options due to network limitations and plan rules.
Finally, you may be exposed to aggressive marketing tactics from MA plans during open enrollment and throughout the year. It’s important to research options critically and not get swayed by promises without considering the plan’s limitations.