My kids keep telling me to get a Medicare Advantage plan, but my friends say stick with Original Medicare. Who should I listen to?

Question

Cynthia Nakaya · Accepted Answer

Original Medicare has deductibles and co-insurance and doesn't include drug coverage-part D (If you don't have a PDP- Prescription Drug Plan-and haven't had one for over 63 days after your initial enrollment period has passed, you'll pay a lifetime penalty when you sign up.) With original Medicare, you can go to any doctor who accepts it.

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.

Lt Col Tim Brown · Answer

Original Medicare only pays 80%. So if you had a $30,000 out patient surgery and only had Medicare, your co-pay is $6,000. Under a medicare advantage plan it is (depending on the company) $270 to $300. Yes, Original Medicare is costly. I agree with your kids as I and my wife chose a medicare advantage plan.

Answered by Lt Col Tim Brown on May 9, 2025

Broker Licensed in TN, AL, CO & 10 other states

Answered by Lt Col Tim Brown Medicare Insurance Agent

Tony Capraro III · Answer

Someone who deals with helping clients with Medicare planning every day! Get the facts-not the hype! Work with someone who can explain the "medicare alphabet soup" so it's easily understandable and who also sells both: Medicare Supplement/Medigap AND Medicare Advantage! We can go over all the Pros and Cons of each plan and with staying with Original Medicare!

Answered by Tony Capraro III on April 7, 2025

Agent Licensed in NH & ME

Answered by Tony Capraro III Medicare Insurance Agent

Marsha Reiniers · Answer

The plan you choose is totally your choice, not your kids, and not your friends and neighbors. Both types of plans have their advantages and disadvantages. Be sure to take the time to understand exactly how both these approaches to your healthcare work, and then you can make your own educated decision about what is best for you.

Answered by Marsha Reiniers on April 7, 2025

Agent Licensed in FL, GA, NC, PA, SC & VA

Answered by Marsha Reiniers Medicare Insurance Agent

Richard Moreno · Answer

It depends on your needs and also if you are able to pay 20% of all services covered by Medicare. You will need to get a medical plan to help cover the 20% but you need to be able to afford the premium which increase with age

Answered by Richard Moreno on May 31, 2025

Broker Licensed in TX, FL, LA, NM & OH

Answered by Richard Moreno Medicare Insurance Agent

Steven Lovell · Answer

You should listen to a medicare specialist to help determine your financial needs, your health care concerns and who's gonna pay the ultimate bills in the future. If something was to happen to you, your friends unfortunately are not experts and your children may be responsible for paying the bills making the decision for you that may not be in your best interest.

Answered by Steven Lovell on May 10, 2025

Broker Licensed in GA, CA, FL & 7 other states

Answered by Steven Lovell Medicare Insurance Agent

Shelly Hefley · Answer

Each person is different and I look at financial situation and Health. If you’re in bad health and can’t afford a supplement then that might be the way to go…. But if you’re financially struggling, there are a lot of good advantage plans that may save you money and give you some extra benefits

Answered by Shelly Hefley on April 9, 2025

Broker Licensed in IN, AL, IL, KY & TN

Answered by Shelly Hefley Medicare Insurance Agent

Jeremy Henry · Answer

This is tough because we talk with friends and family to get different perspectives which is natural, however I would tell anyone in this situation to try to look at it from a neutral perspective, at least as much as you can.

When I sit with a client we go over what I call a "Medicare 101". My goal is to educate my client on these two options by going over the pros and cons of both. That way in the end they can make an educated decision on what is best for them.

Steve Brauer · Answer

Since Medicare is not a "one size fits all", you should listen to your Independent Medicare Broker. We are trained and hopefully knowledgable about the industry and products in your area. In my opinion, you MUST find someone that only does Medicare, since you can't be an expert at everything.

Answered by Steve Brauer on April 16, 2025

Broker Licensed in AZ & CA

Answered by Steve Brauer Medicare Insurance Agent

Carol Thompson · Answer

I would say not to listen to neither. If you want an opinion then get a professional opinion from an insurance broker/agentand it’s Free! 

The role of an insurance broker is as such: each and every year we have to be tested for the changes of Medicare  laws/ guidelines and go through training to know the changes of the plans as they can change yearly. Seek professional help- often times
I have saved people quite a bit per year.

Suzanne Lamperti · Answer

Original Medicare is a better choice if you don't have specific or chronic issues. Medicare Advantage us more limited, you can't go to a doctor or specialist of your choice. If you do, they normally won't cover. If you travel, Originall Medicare is a better choice. Medicare Advantage is more restrictive.

Answered by Suzanne Lamperti on April 11, 2025

Broker Licensed in MD

Answered by Suzanne Lamperti Medicare Insurance Agent

Barbara Barnes, CMIP® · Answer

You should decide for yourself because only you know what your priorities are.

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.

Sonya Chandler · Answer

You have to do what's best for you.  As everyone's situation is different.  I would explain the Medicare Advantage Plans and Original Medicare and help you to make an informed decision.

Tanja Roulhac · Answer

Choosing between Original Medicare and a Medicare Advantage plan depends on your personal health needs, preferences, and circumstances. 

Original Medicare (Part A and Part B)
Coverage: Hospital insurance (Part A) and medical insurance (Part B).

Flexibility: You can see any doctor or specialist that accepts Medicare without needing a referral.

Costs: You pay premiums for Part B, and typically deductibles and coinsurance for services.

Additional Coverage: You may need to buy a separate Part D plan for prescription drugs and/or a Medigap policy for extra coverage.

Medicare Advantage (Part C)
Coverage: Includes everything Original Medicare covers plus often additional benefits like vision, dental, hearing, and sometimes prescription drugs.

Network: Generally requires you to use a network of doctors and hospitals; may require referrals for specialists.

Costs: Often lower premiums than Original Medicare + Medigap, but you might have copayments or coinsurance with each service.

Extra perks: Some plans offer fitness programs, transportation, or wellness benefits.

Who to Listen To? You decide what is best for you.  I am available to assist with Part D carriers or if you choose a Medicare Advantage, I will assist you with choosing the carrier that best meets your needs.

I hope this helps.

Tanja Roulhac,
Licensed Medicare Broker

Donald Baker · Answer

Every circumstance is different. You should meet with a licensed insurance advisor to discuss your individual situation, .

Renee Pena · Answer

The best choice for you depends on your personal health needs, financial situation, and preferences. That's a benefit of having a trusted agent to discuss your specific circumstances to get tailored advice.

Answered by Renee Pena on May 15, 2025

Broker Licensed in TX, CA, CO & 12 other states

Answered by Renee Pena Medicare Insurance Agent

Patrick Lohrey · Answer

Listen to your friends. They probably have friends who have experienced many of the pitfalls associated with owning Medicare Advantage. Your kids probably listened to Joe Namath on those phony Medicare Advantage TV adds.
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

My kids keep telling me to get a Medicare Advantage plan, but my friends say stick with Original Medicare. Who should I listen to?

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My kids keep telling me to get a Medicare Advantage plan, but my friends say stick with Original Medicare. Who should I listen to?

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