As a senior, what should I know about the differences between Original Medicare and Medicare Advantage before I choose?

Question

Comfort Olude · Accepted Answer

Basic Original Medicare by itself covers Part A (hospital stays) and Part B 
( doctor visits). You usually pay a monthly Part B premium, which is paid by Social Security Administration from your benefits, and you must meet yearly deductibles. Original Medicare will then cover 80% of the approved amount, and you're responsible for the remaining 20% of the cost of care. There is no limit to your out-of-pocket cost each year. You may need a supplemental insurance plan to cover 20% of the cost of care and prescription drug coverage.

Medicare Advantage plans are more comprehensive plans that support your entire well-being, so you can live a better, healthier life. You usually pay a monthly Part B premium, which is paid by Social Security from your benefits. 
In one package, it gives you Part A and Part B coverage, plus Part C coverage.
Many plans also include Part D prescription drug coverage. It has limited out-of-pocket cost, It has more predictable co-pays, and a cap to your yearly out-of-pocket expenses.

Larry Dalton · Answer

You can always convert your Medicare Insurance plan from the traditional or original Medicare coverage with a supplemental plan to a Medicare Advantage plan "at any time" throughout your life, regardless of your health conditions.  

However, converting back from a Medicare Advantage plan to the original Medicare A & B with a Medicare supplemental plan could present a significant problem.  Why?  After passing up the special exemptions period (known to some as the Golden Opportunity), with Medicare supplement plans, then the insurance companies have the right to evaluate your healthcare conditions before accepting you into one of their Medicare supplemental or Medigap plans.     Health examinations or health questions are not utilized to determine the approval of a Medicare Advantage plan.

William Gray · Answer

Original Medicare is a point of service plan you do not have to choose a network provider and can go to any doctor who accepts Medicare. 

With a supplement to Medicare you can reduce your liability to a few hundred dollars per year. 

These plans will have a premium.

Medicare part C "Advantage" plans are Medicare replacement plans.

You will likely need to use network doctors to receive the best rates or to be covered at all.

There are more significant copays and out of pocket limits.  But many plans have zero additional premium.

Randall Taylor · Answer

You need a consultation with a qualified Medicare Specialist. There's a lot of information and can be confusing if you try to do this on your own.

Norman Smith · Answer

The most important questions to ask yourself are these:

1) - As I age, will my health get better or worse?
2) - How important is it for you and your family to have the election of any doctor or facility in the USA?
3) - How important is it to be in control of your own health, as opposed to a private company making decisions for you?

If the answer to the first one was anything other than "worse", you are fooling yourself.
 
And if the last 2 aren't important to you at all, and you are fine with staying in a network of chosen health professionals that may or may not be top in their field, you are happy getting referrals from the PCP you are allowed to see - to see specialists, etc., and are focused on the "freebies" an MA plan can give you, then you should take one of their plans. Otherwise, Original Medicare with a proper supplement plan is the best choice.

Dana Dane · Answer

I would call an agent and meet face to face if you can.  They can educate you on the plans available in your area and find out what type of plan would be best for you.

Cleo Martin · Answer

With Original Medicare you pay a premium each month. Then depending on the plan you pay the deductible. After deductible is paid then Medicare pays it part and the supplement pays the rest of what is owed. There are NO networks for doctors or hospitals, so you can go to who ever you want without a referral.  Now the premium on Medicare supplement can go up each year as you get older but as long as you pay the premium you can't be canceled. There is no dental or Hearing benefits,  and no silver sneakers.  With Medicare Advantage  it is managed care by insurance companies.  Usually there is no premium but a cost everything you use it. Be it a specialist, trays, MRI's?, hospitals. There is maximum out of pocket you would pay each year. Your doctors and hospitals need to be in their network. They do give you dental, vision, hearing and some other benefits. Drug benefits are included with MA, you have to buy a separate drug card with original Medicare.  These are some of major differences.

Cleo Martin 
803-730-8368

Natalee Nimmo · Answer

That is gonna depend on where you live if you have Medicare or Medicare & Medicaid, plus it’s also going to depend on the Medicare Advantage carrier and the plan that you’re considering. This is not a quick answer type of question. This is the type of question you wanna ask a broker or agent about and let them pull up The information on whatever plan you’re looking at and give you the differences between the two from there.

On the surface, I can say that networks is a big difference. Medicare advantage has networks Medicare supplement does not. Prior authorizations is a big difference, Medicare advantage has prior authorizations, and Medicare and Medicare supplement does not. Understand that with Medicare advantage plans, the doctors and hospitals can decide in the middle of the year or basically at any time of the year, that they no longer wanna take that plan anymore. With original Medicare and a Medicare supplement that does not happen. Another big difference is going to be co-pays, deductibles and Max out-of-pocket amounts.

As a senior, what should I know about the differences between Original Medicare and Medicare Advantage before I choose?

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As a senior, what should I know about the differences between Original Medicare and Medicare Advantage before I choose?

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