My kids keep telling me to get a Medicare Advantage plan, but my friends say stick with Original Medicare. Who should I listen to?
Answered by 8 licensed agents
Answered by Tony Capraro III on April 7, 2025
Agent Licensed in NH
Answered by Marsha Reiniers on April 7, 2025
Agent Licensed in FL, GA, NC, PA, SC & VA
In 2025, part A has a $1,676 deductible. You pay:
Days 1–60: (of each benefit period): $0 after you meet your Part A deductible ($1,676).
Days 61–90: (of each benefit period): $419 each day.
After day 90: (of each benefit period): $838 each day for each lifetime reserve day (up to 60 days over your lifetime).
After you use all of your lifetime reserve days, you pay all costs.
There's a term here, "benefit period". The benefit period lasts for 60 days. If you are out of the hospital for over 60 days, the process starts over, and you pay the deductible again (lifetime reserve days do not start over).
Part B has a $257 deductible, with generally a 20% co-insurance after it's been met. Original Medicare has no maximum out-of-pocket. If you are in the hospital multiple times during the year, the costs can be financially devastating.
Medicare Advantage plans have maximum out-of-pocket limits built into their plans. Depending on where you live, there are both HMOs and PPOs to choose from. HMOs require referrals to see specialists. PPOs are more flexible but costs for out-of-network doctors are higher.
Another option is Medicare Supplement, which works with original Medicare. If you choose this option, you need a stand-alone PDP. Knowing this information should help you decide who to listen to- your children or friends.
Answered by Cynthia Nakaya on April 5, 2025
Agent Licensed in CA, AZ, CO, GA, MO & TX
Answered by Shelly Hefley on April 9, 2025
Broker Licensed in IN, AL, IL, KY & TN
Answered by Steve Brauer on April 16, 2025
Broker Licensed in AZ & CA
There is no single right answer for which is best between Meficare Supplement and Medicare Advantage. Both work well in their specific ways.
Medicare Supplements use Original Medicare as the base for coverage and Original Medicare allows you to see any provider in the country that accepts Medicare. Medicare Supplement plans generally have less managed care, so they are also easier to use when your doctor wants you to receive treatment ents or to have tests done. Generally, the premium is higher for a Medicare Supplement, but the claims cost is lower. But Supplements do not include ’extra’ benefits like dental, vision or hearing benefits.
Medicare Advantage plans usually require that you see a network provider to receive the higher benefit amount. Some plans will only pay when you see providers who are in network. Advantage plans are also known for managing care to save money, so your doctor will need to have most tests and treatments approved before they take place. You will have a copayment for every service you receive in an Advantage plan, up to a plan-specific out-of-pocket maximum. Generally, premiums are lower (maybe even $0) for Medicare Advantage plans, but claims are higher. Most Medicare Advantage plans do include ‘extra’ benefits, but those benefits vary by plan year and insurance company.
In summary, it is important that you understand all of your options before you make a decision. You should consult with a local Medicare insurance agent before you make a final choice. Your family and friends mean well, but they cannot advise you as well as a licensed insurance agent on this issue.
Answered by Barbara Barnes, CMIP® on April 7, 2025
Agent Licensed in PA
Answered by Suzanne Lamperti on April 11, 2025
Broker Licensed in MD
The reality is you don't get health care for free - not even Medicare. If you want narrow provider networks owned by insurance companies, then select Medicare Advantage. If you want roughly 70% of the services you receive, requiring prior authorizations by the insurance company which allows them to respond by saying, "Not medically necessary," then select Medicare Advantage. If you need major surgery and end up spending 5 days in the hospital, which requires you to pay at least $1,500 out-of-pocket, then take Medicare Advantage.
I could go on. So, give me a call to follow up and to help you select a solid Medicare Supplement Plan. You can put an end to the argument and feel good about your choice. My number is 717-968-9300. _Patrick
Answered by Patrick Lohrey on April 17, 2025
Agent Licensed in PA, DE, MD & VA
Tags: Advice for Seniors Medicare Advantage
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