Is Medicare Advantage Better Than Original Medicare
There is not one universal right or wrong answer when it comes to choosing Original Medicare vs. Medicare Advantage.
If you want the freedom to travel and seek health care from any doctor or provider who accepts Medicare, and if you want the opportunity for more predictable health care spending with the help of a Medigap plan, Original Medicare may be the right choice for you.
If you want to enjoy extra benefits such as dental, vision and drug coverage under one easy plan that also covers your hospital and medical benefits, if you want added protection against potentially high surprise medical bills, or if you want a plan that can offer customized coverage for a specific health condition, then a Medicare Advantage plan may better suit your needs.
Is It Better To Have Medicare Advantage Or Medigap
Were often asked which is best, Medicare Advantage or Medigap? The issue really comes down to peace of mind. You dont need supplemental insurance with Medicare Advantage. However, with Original Medicare, you can get supplemental insurance to fill the gaps. This is the main reason people feel that Original Medicare, with a Medigap policy for supplemental coverage, is better than Medicare Advantage.
If you have access to additional benefits that will take care of some or all of your out-of-pocket costsOut-of-Pocket Costs for Medicare are the remaining costs that are not covered by the beneficiary’s health insurance plan. These costs can come from the beneficiary’s monthly premiums, deductibles, coinsurance, and copayments…., use those benefits. If not, ask yourself if you are prepared to pay up to the maximum out-of-pocket limit on a Medicare Advantage plan.
When it comes to which is better, Medigap or Medicare Advantage, consider this. If the prospect of pulling an average of $4,925 out of your pocket, which does not include your prescriptions or monthly premiums, makes you nervous, then its time to compare the top Medigap plans in your area. When you do, you will find a wide range of coverage options.
Medicare Vs Medicare Advantage: The Basics
If you have original Medicare, the goverment directly pays for your Medicare benefits. In contrast, with Medicare Advantage plans, you receive your benefits from private medical insurance companies that Medicare has approved. There are several types of Medicare Advantage Plans:
The Official U.S. Government Site for Medicare online states that you must live in the service area of you prospective plan and also have Medicare Part A and Part B in order to join a Medicare Advantage Plan.
Both Medicare and Medicare Advantage are also legally required to cover certain basic health services, though the costs you pay and the specific services that are covered vary.
Medicare Advantage began in 1995, though similar programs were available as early as the 1970s. The key distinction between the two programs is that Medicare is government health insurance, while Medicare Advantage is private health insurance that the government helps fund.
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Medicare Advantage Vs Medicare
Medicare Advantage Plans may have provider networks that limit your choices. If you go outside the network, your care may not be covered. With Original Medicare, you generally can use any doctor or medical facility that accepts Medicare assignment.
In exchange for less freedom, though, you often pay less. You would still be required to pay a monthly premium for Part B, but the additional cost for a Medicare Advantage Plan may be less than for a Medigap plan. Sometimes the Medicare Advantage Plan may have a $0 premium.
Medicare Advantage Plans may also have a maximum out-of-pocket limit for covered care. That caps the amount youll be expected to pay in addition to your premiums. Original Medicare and most Medigap plans dont have out-of-pocket maximums.
Learn About Medicare Supplement Plans Available Where You Live
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1 Freed M. et al. . Medicare Advantage 2022 Spotlight: First Look. Kaiser Family Foundation. https://www.kff.org/medicare/issue-brief/medicare-advantage-2022-spotlight-first-look.
2 AHIP. . State of Medigap: Trends in Enrollment and Demographics. Retrieved from https://www.ahip.org/wp-content/uploads/AHIP_State_of_Medigap-2020.pdf.
3 MedicareAdvantage.com’s The Best States for Medicare report. .
4 TZ Insurance Solutions LLC internal sales data, 2019. This data is based on the Medicare Supplement Insurance policies TZ Insurance Solutions LLC has sold. It is not a comprehensive national average of all available Medicare Supplement Insurance plan premiums.
About the author
Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareAdvantage.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.
His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health care and finance blogs.
Christian is a graduate of Shippensburg University with a bachelors degree in journalism. He currently lives in Raleigh, NC.
Where you’ve seen coverage of Christian’s research and reports:
Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE , 24 hours a day/7 days a week or consult www.medicare.gov.
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Medicare Advantage Plan Benefits
Private insurance companies have a bit more flexibility in designing Medicare Advantage plans, so youll find more differences between plans. This means you need to be more careful comparing plan options to make sure you dont overlook anything.
As mentioned, Medicare Advantage plans give you the opportunity to get coverage for benefits beyond Original Medicare. This may include routine vision and dental, hearing, and health wellness programs. Normally, under Original Medicare, youd pay for these services out of pocket unless you have other insurance.
Another benefit of Medicare Part C is that many of these plans also include Medicare Part D prescription drug coverage as part of the plan coverage. Also known as Medicare Advantage Prescription Drug plans, these plans give you the convenience of having all of your Medicare benefits administered through a single plan.
If you enroll in a Medicare Advantage Prescription Drug plan, you will not need to enroll in an additional Medicare Prescription Drug Plan. In fact, if you are enrolled in a Medicare Advantage plan that includes prescription coverage and also enroll in a stand-alone Medicare Prescription Drug Plan, you could be automatically disenrolled from your Medicare Advantage plan.
What Exactly Is The Advantage Of Medicare Advantage Plans
Most often the advantages that make Medicare beneficiaries choose an advantage plan are:
|Advantage plans generally offer addition||These include dental, vision, or hearing|
|There is an annual maximum to your out-o||Each plans ceiling is different, but Ad|
|Prescription drug coverage is generally||You may save money by choosing a low or|
|Certain out-of-pocket expenses may be lo||Some plans have no deductible for medica|
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How Are Medigap And Medicare Advantage Different
Medicare Supplement Insurance plans can help provide coverage for some of the out-of-pocket costs that are tied to Original Medicare. These costs can include Medicare deductibles, coinsurance, copayments, excess charges and more.
Medicare Advantage plans provide the same benefits of Original Medicare combined into one single plan. Many Medicare Advantage plans may also offer additional coverage for things like dental, vision, hearing, prescription drugs and more.
To put it simply, Medigap plans are used in addition to Original Medicare and provides coverage for health care expenses. Medicare Advantage plans are used as an alternative to Original Medicare and provides coverage for health care services.
Reason : Plan Benefits Costs And Providers Change Every Year
This is true. Under the rules set out by the Centers for Medicare and Medicaid ServicesThe Centers for Medicare & Medicaid Services is the U.S. Federal agency that runs the Medicare, Medicaid, and Childrens Health Insurance Programs…. , insurers may change the benefits and costs in their plans. They are also allowed to change their provider networks.
This is the primary reason Medicare Advantage members should compare plans every year. Unfortunately, most enrollees dont.
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What About The Medicare Advantage Give Back Benefit
The give-back benefit allows some Medicare Advantage plans to offer plan members a rebate on their monthly Medicare Part B premium. Beneficiaries with a give-back plan receive the benefit through Social Security. No direct payments are allowed.
The technical term for the benefit is Medicare Part B premium reduction. When you enroll in one of these plans, the insurance carrier pays some or all of your premium. In the evidence of coverage document the plan is required to provide, you will find a section titled Part B Premium Buy-Down. This is where you will find the amount the plan contributed towards your Part B premium.
Plans with a give-back benefit are becoming more popular, but they are still not widespread. The largest companies offering these plans include Aetna, Cigna, and Humana. Give-back amounts range from as little as $.10 to as much as the full, standard Part B premium.
If you pay your own Part B premium you are eligible for a give-back plan. If you have full or partial Medicaid, including aid through a Medicare Savings Program, you are not eligible.
Do You Want Extra Coverage
Original Medicare includes Part A and Part B . Heres a look at what that coverage includes.
Participation in some clinical trials
Original Medicare has a long list of services that are excluded from its coverage, detailed in a Medicare Learning Network booklet.
Medicare Advantage plans are required to cover everything that Original Medicare covers. Some plans stop right there, but others include additional coverage, such as vision and hearing care, care in foreign countries, gym memberships, and even transportation to and from medical appointments.
Original Medicare Vs Medicare Advantage: Providers
A final key difference to consider when choosing between Original Medicare and a Medicare Advantage plan is what health care providers you can see.
With Original Medicare you can go to any hospital and see any doctor or provider within the U.S. who accept Medicare. You do have limited coverage in foreign countries, though.
With Medicare Advantage, most plans have a network of doctors and providers you can see. If you go outside the plans network, its likely youll have to pay more to do so. However, emergency and urgent care are covered nationwide. You also have limited coverage in foreign countries, though some plans may offer special foreign coverage or travel benefits.
Medicare Supplement Insurance Plan Benefits
There are 10 Medigap insurance plans available in most states, and each plan type is designed by a different letter . Coverage is standardized across each plan letter, which means youll get the same basic benefits for Medicare Supplement coverage within the same letter category, no matter which insurance company you purchase from. However, even if basic benefits are the same across plans of the same letter category, premium costs may vary by insurance company and location. If you live in Massachusetts, Minnesota, or Wisconsin, keep in mind that these three states standardize their Medigap plans differently from the rest of the country.
Medigap plans cover out-of-pocket costs not covered by Original Medicare, such as copayments, coinsurance, and deductibles. Some plans may help pay for other benefits Original Medicare doesnt cover, such as emergency health coverage outside of the country or the first three pints of blood. Medigap plans dont include prescription drug benefits. If you dont already have creditable prescription drug coverage , you should consider buying a separate stand-alone Medicare Part D Prescription Drug Plan to cover the costs of your prescription medications. Also, Medicare Supplement insurance plans generally dont offer extra benefits like routine dental, vision, or hearing coverage beyond whats already covered by Medicare.
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Medicare Star Quality Ratings
Our Medicare Advantage health plan was rated 4.5 out of 5 Stars in Washington for 2021. The Medicare Star Rating is based on quality, service, and member satisfaction. Our high rating means you can have peace of mind knowing that you’re getting high-quality care and coverage all in a single plan at a great value.3
Medicare Vs Medicare Advantage: Differences
Both Medicare and Medicare Advantage will fund most basic health costs, including doctor’s visits and hospital stays. The specific cost of each plan, as well as the out-of-pocket copays and other costs, vary. Some key differences between the two programs include:
- Original Medicare includes Medicare Part A and Part B only. People who want prescription drug coverage must purchase a Medicare Part D plan. Medicare Advantage often includes Part D, and may offer coverage for services original Medicare will not cover.
- You can use original Medicare at any doctor or hospital that accepts the program. Medicare Advantage programs may limit you to specific in-network providers.
- Out-of-pocket costs with Medicare Advantage plans are usually lower.
- The government sets prices for various services offered under original Medicare plans. With a Medicare Advantage plan, you may pay a different rate based on the rate negotiated by the insurer. This rate may be higher or lower than the original Medicare rate.
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Why Should I Enroll In A Medicare Supplement Insurance Plan
When you use Medicare Part A or Part B benefits, youll often be left with some out-of-pocket expenses like deductibles, coinsurance or copayments. This is known as cost sharing.
Thats where Medicare Supplement Insurance comes into play. As the name implies, this type of plan is used alongside your Original Medicare coverage.
Here are a few examples of how a Medigap plan can work:
Original Medicare Coverage Doesn’t Cut It Here Are Ten Factors To Help You Decide Which Private Insurance Options You Might Need
You can opt for Original Medicare and supplement it with a Medigap plan and/or a Part D prescription plan, or you can choose a Medicare Advantage plan.
Once youve decided that you want more coverage than Original Medicare alone, the next step is figuring out which of the many private insurance options will best fit your needs and budget.
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What Are The Cons Of Medicare Advantage
- Restricted service area, which may be an issue if you travel or reside in a different area for part of the year
- The in-network benefit of cost containment can mean limited choice of providers.
- You may have to wait for prior authorizations for medications and treatments, or spend time up-front trying to get advance plan approval.
- You most likely will need a referral prior to seeing a specialist.
- If you had Original Medicare with a Medigap plan previously, then choose a Medicare Advantage plan, it may be difficult to switch back and return to your previous Medigap plan.
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What Are The Pros And Cons Of Medicare Advantage Vs Original Medicare
Fact checked Reviewed by: Leron Moore, Medicare consultant –
When you become eligible for Medicare, you can choose from one of two main ways to get your Medicare coverage. You can opt for Original Medicare or a Medicare Advantage plan . It is important to weigh the pros and cons of each, taking into consideration your preferences, needs, and budget.
What you should know
- 1Medicare beneficiaries can choose to get their health care coverage through Original Medicare or a Medicare Advantage plan, and it is important to explore options based on preferences, needs, and budget.
- 2Original Medicare allows you to see Medicare-approved providers anywhere in the United States, but depending on how much healthcare you need, costs can be unpredictable.
- 3Medicare Advantage plans offer more benefits and have a limit on out-of-pocket costs, but generally require use of in-network providers and referrals for specialists.
- 4Original Medicare is a government plan, while Medicare Advantage plans are managed by private insurance companies. In either case, you pay a Part B monthly premium.
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Pros Of Medicare Advantage
In some areas, there are plans with zero-dollar premiums available. Some also have a Part B give back option built-in. They have an out of pocket maximum limit. Medicare Advantage plans can come with additional perks like dental, vision, and hearing benefits. Some plans may even include gym memberships, as well as long-term care benefits. Many Part C plans include coverage for prescription medications.
When It Comes To Cancer What Does Medicare Advantage Cover
Medicare Advantage, also known as Medicare Part C, replaces coverage for Medicare parts A, B, and sometimes D. According to the Centers for Medicare & Medicaid Services, all Medicare Advantage plans must provide the same services as Original Medicare, including:
- Inpatient hospital stays such as inpatient cancer treatments
- Outpatient radiation treatment
- Hospice care
- Some cancer screenings
Because chemotherapy is covered under Medicare Part D, a Medicare Advantage plan with Part D included will cover chemotherapy treatments.
âWhen chemo and radiation are administered, the most a Medicare Advantage plan can charge in coinsurance is 20 percent. While the coinsurance can vary from plan to plan, almost all pay to charge the max of 20 percent. There are some that charge less, but those are rare,â Christopher Duncan, founder and independent broker at Trusted Benefits Direct, tells WebMD Connect to Care.
Medicare Advantage plans must provide the same coverage as Original Medicare. The Centers for Medicare & Medicaid Services notes that, for breast cancer patients, this coverage includes:
- Surgically-implanted breast prostheses after a mastectomy
- Post-mastectomy external breast prostheses, including a post-surgical bra
Medicare Advantage HMO plans have a restrictive network. Aside from emergency care, you would have to see the doctors, hospitals and providers within your chosen HMO network.
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