Should I keep original Medicare or go with an Part C, Medicare Advantage plan? What is better?
Answered by 31 licensed agents
What is better for one Medicare beneficiary, could be the biggest mistake for you. Unfortunately, there is no 'better' or 'best' when it comes to choosing your Medicare path. It is important that you work with a trusted broker to clarify your options.
Original Medicare only should not be a consideration for most people. The financial gaps within Original Medicare will be catastrophic to most people. However, Original Medicare + a Medicare Supplement plan is what you will want to compare to a Medicare Advantage Plan.
Most of our Medicare clients come down to the conclusion that it's Freedom VS Cost. The Medicare Supplement provides freedom of choice for a Medicare beneficiary, but typically at a higher monthly cost. The Medicare Advantage plan often has a $0 monthly premium for the plan itself, but you are often bargaining with some of your freedom of choice, such as what doctors you can see.
Regarding the cost of a Medicare Supplement or Medicare Advantage plan, we are referencing what Medicare Supplements & Medicare Advantage plans cost in the state of Florida, as costs can vary across the USA.
Original Medicare (OM) is an 80/20 health plan. If hospitalized, the government pays 80% and you pay 20% of the costs. There is no limit on your 20%. A Part C (Advantage Plan) would cover a lot of these costs that OM does not. A Part C plan can also give you coverage for prescription drugs, vision, dental and hearing that OM does not.
Original Medicare has no Rx, dental, vision, hearing or OTC benefits. You would need separate policies to have them and the Part D or Rx plan is mandatory or your will be fined for life.
It also doesn't pay for copays and deductibles. And, of any expenses you incur, you will owe 20%.
A Part C or MAP+D plan comes with all of the benefits or 90% of the benefits above (depending on the plan and service area) and has a MOOP (Maximum out of pocket) so you know that the most you will ever pay vs the 20% of Original Medicare is a set amount. Then, you are covered 100% for the remainder of the year.
That safety net and the fact that MAP+D (Part C) plans are very affordable is really what you have to consider.
I'm a pretty firm believer that Original Medicare is only the best choice when paired with a supplement. The reason is simple. There is NO max out of pocket to Original medicare. Part C is a great choice for those that do not mind paying low copays and enjoy the low premiums, but at minimum they at least have a max out of pocket in case something catastrophic happens
If you keep original Medicare, you will need to evaluate your options for a Medicare Supplement and Part D drug plan, OR a Medicare Advantage plan. A Medicare Advantage plan is a health managed, “all in one” type plan, and typically includes a drug plan, as well as other ancillary benefits, like vision, dental. The route you take really depends on your own lifestyle, budget, and health care perspective. Talk to an agent who is contracted to sell both types of plans so you can make your own educated decision about the plan that works best for you.
Original Medicare lets you see almost any doctor, but it doesn't cover everything. Medicare Advantage (Part C) usually has extra perks and lower costs, but depending on the plan you have to stick to their network.
IF cost isn't a factor then for your medical coverage I think traditional Medicare with a supplement is better. Hands down. Why? Medicare Advantage plans have too many dis-Advantages. There are networks and it's always harder to stay in-network than it should be. There are plan changes every year. The Out-Of-Pocket Maximums can be significant financially.
Then there is the issue of control. With Medicare Advantage you are essentially giving your Medicare over to the insurance company to manage. Are they going to manage it in your best interest or their best interest? I'm sure you have heard the term "prior approval" or "utilization review"...or maybe your doctor just said, "I'd like to do a "such and such" test, but we have to check with the insurance company to make sure they will pay for it.
There's a lot more of that with Medicare Advantage. There are some prior approvals with traditional Medicare, but they really are just looking for fraud, waste, and abuse...they aren't trying to protect their stock price or their executives compensation package.
With traditional Medicare and a supplement you and your doctor have more control of your healthcare.
Now...all that being said...it's going to cost a little more. Most Advantage Plans have plans that are $0 a month (Keep in mind you have to pay your Part B premium whatever your choice is). There is a cost for keeping control of your healthcare and that is the cost of a Medicare Supplement and a Drug Plan (Part D). The price of that supplement will likely go up every year. What you start out paying is not what you will end up paying.
Choosing between an original Medicare plan and a Medicare Advantage plan depends on your budget, care needs, desired benefits and preferred doctors. Medicare is the federal health insurance program designed for people over age 65, as well as those under 65 with qualifying disabilities. Medicare Part A (inpatient care) and Part B (outpatient care) are known as original Medicare. Medicare Advantage, or Medicare Part C, refers to plans offered by private insurance companies. These plans offer coverage comparable to original Medicare as well as some additional benefits, such as vision or dental coverage. I would need a little more information to advise on which option is best for you. Please contact me at your convenience.
Original Medicare covers Part A Hospital/Inpatient Services & Part B Medical/Outpatient Services only. It does not include Part D/prescription coverage and you'll be subject to the 20% coinsurance that Original Medicare does not cover, nor does it include additional benefits that Medicare Advantage plans provide. With that said, the question should be do I go with a Medicare supplement/ Medigap plan or Medicare Advantage plan/Part C. These are the options to consider when it comes to reducing your out-of-pocket cost that Original Medicare does not cover.
That would depend on your own personal needs and financial situation. You would need to talk to an agent that is versed and knowledgeable on both plans and can explain all options available to you and what would work best for you personally. I don’t feel there is a one size fits all plan but should be individualized for you.
That lies in whether or not you want to pay more or less in copayments and large MOOP deductibles. If you keep original medicare and you don't have a medicare supplement, you're going to be paying copayments and large deductibles. If you go with a medicare part c medicare advantage. You're gonna have copays and large deductibles. If you go with a medicare supplement, you'll have a premium, one small annual deductible and no copayments.
If you go with part C (Medicare Advantage plan), you'll get additional benefits such as dental, vision, hearing and your par D (prescription drug coverage is included. Also, you avoid the 20% charge Medicare doesn't pay.
I would definitely with out reservation enroll in a Medicare Advantage plan before ever staying with original Medicare A and B. I can explain with one benefit and that the max out of pocket Advantage plans have to offer by federal law.
This max out of pocket will protect you if you have a bad health year so you’re limited, protected on what you would spend on Medicare approved health care. Keep in mind if you’re trying to keep your out of pocket cost at a minimum you may want to to consider adding a hospital indemnity to your Medicare advantage plan. Even adding this you’re still saving more money going this route than with a supplement. Just keep in mind Medicare advantage plans are not Medicare supplements and you will have to get prior authorization and need to stay in network for the most cost savings with advantage plans. But they do offer additional benefits supplements or original Medicare don’t offer. I hope that helps you make your decision.
That question is difficult to answer unless you know the individual's health status. Everyone is unique, and I would need to know if they travel, which doctors they see, what medications they are taking, etc.
The choice between Original Medicare and a Medicare Advantage (Part C) plan depends on individual needs and preferences. Original Medicare provides the most flexibility in choosing healthcare providers, but may have higher out-of-pocket costs and doesn't cover many "extras" like routine vision, hearing, and dental care. Medicare Advantage plans offer a wider range of coverage, often including those extra benefits, but with network restrictions and potentially higher premiums.
Original Medicare offers more flexibility in choosing doctors and hospitals, while Medicare Advantage plans often provide extra benefits and lower costs,
There is no "pat" answer to this questions. The variables are: #1 Where do you live, in a rural or urban area? Urban areas typically have more Dr's who take Advantage plans. #2 Did you or an agent, research your current Dr's to see which Advantage plans they accept? #3 Do you live in one place, or do you have a home in another state that you frequent? #4 Can you afford a Medicare supplement plan?
Deciding on whether what plans to go with depends on your personal needs. It is important to consult with a licensed broker for guidance on what will best suit your needs.
That depends on your health care needs. Do you have conditions which need special services? Most Part C plans Don include prescription coverage. Can you afford a Meducare Supplement? These are things you need to consider.
I would strongly recommend that you take the time to look at all of your doctors, hospitals, and the services that you will need in the future. The MAPD{Part C} may be best for you, but you have to look at the complete picture. You may need to have a Medicare Supplemental plan or a MAPD (Part C) with a hospital indemnity plan.
Great question! As a Medicare recipient you have choices.
Option A- Using Medicare Parts A and B to pay for your hospital and medical related bills in the future using Medicare’s formula of 80%/20% split. Medicare pays 80% you would be responsible for the remaining out of pocket (OOP) of 20%, and purchase a separate Prescription Drug Plan, or
Option B- After being granted Medicare Parts A and B. Choose a Medicare Advantage plan offered in your area that will help manage your Medicare by adding additional benefits and services that will help keep you healthier with annual Preventative exams, teeth cleanings, eye, ear and vision exams with minimal copays and in most cases $-0- cost to you.
A seasoned Broker can review a variety of plans in your area that competing carriers offer. To assist you further, Brokers have the ability to reveal each plan’s 5-star rating that help you determine the Medicare Advantage plan that’s right for you.
The best plan is the one that will address all in not most of your needs and piece of mind.
The answer varies based on your unique individual needs. Healthcare, especially within Medicare, is not a one-size-fits-all. My advice woudl be to speak with a reputable agent who can properly compare both sides and help you guage what suits you better.
Original Medicare offers flexibility to see any provider nationwide but lacks drug coverage and an out-of-pocket cap, risking higher costs. Medicare Advantage (Part C) bundles benefits, often includes extras like dental, and caps costs (e.g., $8,850 in 2025), but limits you to networks and may require prior approvals. If you want choice, consider Original Medicare with Medigap; if you’re healthy and prefer lower premiums, Advantage might suit you. Compare plans at Medicare.gov during open enrollment (October 15–December 7, 2024).
In order to apply for a PART C Medicare Advantage plan you must have Medicare Parts A and B. Remember that original Medicare is only an 80/20 plan. This means that any medical bill that you receive, you will pay 20% of the bill. For example, if the bill is $10,000 you will be responsible for $2,000.
If you stay with only Medicare, your next thing you have to do is get a Part D drug program.
Going with a Medicare Advantage, Part C will have a Built in Part D along with many other extra benefits to complimenting and expand benefits under Medicare. Some plans have zero or a small premium for the Medicare Advantage plan.
Both original Medicare and Part C, Medicare Advantage plans have their benefits and drawbacks and to blanketly say one is better than the other would be hard to say. This is why having a licensed broker, who specializes in both original Medicare and Medicare Advantage plans learn about the seniors own unique situation and help educate them would be important. Once the senior is fully informed, they themselves can make the decision on what would work best for them. I hope this helps.
It's definitely not a matter of what's better. It's a matter of what your needs are. Original Medicare works great, however, depending on your needs, you may want to look into a Medicare supplement to go with your original Medicare. And those work differently than a Part C, Medicare advantage plan will. Again, it's all about your needs and what fits and works best for you and you healthcare.