What are the different benefits of Medicare Advantage from Medicare? Is Medicare Advantage more beneficial for someone with several health issues? Do more doctors accept Medicare Advantage? Do you pay more out of pocket for Medicare Advantage-premiums and doctor’s bills. Should I talk with an insurance agent?

Question

Norman Smith · Accepted Answer

Wow! You have a lot to decipher here, so let's start from the top!
In its simplest form, MA plans keep you in a Network; Original Medicare allows you the freedom to choose your Doctors, Specialists, and hospitals from anywhere in the country. Freedom or limited control of your health decisions is what you're looking at here. 
MA Plans are not beneficial for someone with several health issues. There may be chosen specialists in the field, and to your needs, but I would always need to consider their expertise in the field. For example, very few, if any, MA plans are accepted at the best facilities in the country, such as the Mayo Clinic, Johns Hopkins, Cleveland Clinic, Moffitt, etc. And this will lead to the next question's answer - No. Fewer doctors are actually accepting MA plans, and much of this is due to the rate of pay for services and the length of time it takes to receive payment from the Payer. If you were to receive less and wait longer as a Medical Professional, you would prefer not to accept it! Therefore, the best, won't!
The way I explain it, MA plans are front-end loaded, where you may not have any monthly premiums, but you will be contributing to Copays or Co-Insurance, and your MOOP (Maximum Out-of-Pocket) could be anywhere from $ 2,500 to $18,000, for example. And you will need to try to stay In-Network for all your services. Consider also that a Medical Professional may accept MA this year, and then not the following, and you could find yourself searching for a new PCP each year. 
You would seek a Professional for Legal issues, your car, your education, etc. Why would you not want to sit with a professional for the biggest health decision concerning the health for the rest of your life? I'd recommend speaking with a professional. Good luck!

Nathan Danovski · Answer

Medicare Advantage (Part C) offers some different benefits compared to Original Medicare. It often includes additional services like dental, vision, hearing, and prescription drug coverage, which Original Medicare does not cover unless you buy separate plans. Medicare Advantage plans also have an annual out-of-pocket maximum, which can provide financial protection if you have high medical costs—something Original Medicare lacks. However, Advantage plans typically require you to use a network of doctors and hospitals, meaning fewer doctors accept them compared to Original Medicare, which is accepted by most providers nationwide. This can be a drawback, especially if you see many specialists or need care from providers outside the plan's network. While premiums for Medicare Advantage plans are often lower, you may pay more out of pocket through copays and coinsurance when you actually use services. In contrast, Original Medicare combined with a Medigap plan and Part D drug coverage usually costs more per month but offers broader access to care and more predictable costs. For people with multiple or serious health issues, the choice depends on whether they value flexibility and access (Original Medicare) or lower premiums and extra benefits (Medicare Advantage). It's wise to speak with a licensed, independent insurance agent who can compare multiple plans.

Answered by Nathan Danovski on August 29, 2025

Broker Licensed in NC, GA, SC & TN, VA, WV & WY

Answered by Nathan Danovski Medicare Insurance Agent

Sherry Rose · Answer

I personally believe it is a personal decision which you feel is best however I can say you have an open network with Medicare and a supplement meaning if they accept Medicare the supplement picks up. With a supplement you can go to any doctor in the US that accepts Medicare. More doctors take Medicare than the Medicare Advantage. You normally have more out of pocket cost with a Medicare Advantage if you use the plan it normally has a lower monthly premium than the Supplement. I would recommend speaking to an agent to answer these questions in detail.

Answered by Sherry Rose on August 29, 2025

Broker Licensed in Ga, AL, AR & 5 other states

Answered by Sherry Rose Medicare Insurance Agent

Steve Houchens · Answer

You should definitely talk with an agent to discuss options and be sure you understand those options. There are certain specifics that need to be done before anyone can discuss plan details about Medicare Advantage and Perscription Drug plans such as a Scope Of Appointment to give permission to discuss certain aspects. Its important to know and understand the deferences between the types of plans available.

Answered by Steve Houchens on August 29, 2025

Agent Licensed in KY & TN

Answered by Steve Houchens Medicare Insurance Agent

Suzanne Lamperti · Answer

To be sure if a Medicare Advantage Plan's benefits are legit, look up reviews online or call the plan and ask. You can also call Medicare and ask.

Carol Thompson · Answer

Yes, consulting with an insurance agent/broker is beneficial to see what plan best suits your individual needs. As a broker, my first request is a list of your doctors’ names that you see and a list of your medications to see what plan best suits you. Your finances may be a factor as well in what type of plan to go with.

Answered by Carol Thompson on August 29, 2025

Broker Licensed in FL, LA, MI & NC, SC, VA & WI

Answered by Carol Thompson Medicare Insurance Agent

Raid Alemam · Answer

The difference between original Medicare and Medicare Advantage is
Medicare: Part A hospital, Part B doctors' visit, and prescription drugs run by the federal government, with no maximum out-of-pocket, requires a premium for Part B and may include Part D
Medicare Advantage is run by private health insurance companies. It covers original Medicare parts an and B, which offer more benefits such as dental, vision, and hearing, and covers part D prescription drugs. It may limit doctors' access to the network or require referrals. May have a maximum out-of-pocket.
Yes, it would help to speak to a licensed Medicare agent, 
It depends on the insurance plans that are offered in your area. You can compare premiums, deductibles, maximum out-of-pocket, and compare to original Medicare.

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