Medicare is an important aspect of senior healthcare. It allows you to plan for your healthcare as you approach retirement age.
However, there are several Medicare options that might make it seem a bit overwhelming to make a choice. Here, we'll explore Original Medicare and Medicare Advantage and how to make good health insurance choices.
Original Medicare
Original Medicare consists of Part A (hospital insurance) and Part B (medical insurance). It’s run by the federal government, and you can see any doctor or specialist who accepts Medicare across the country. There are no network restrictions, so it's ideal for those who travel frequently or want several healthcare providers.
However, while Original Medicare covers many services, there are gaps. For example, it does not cover routine dental, vision, or hearing services. Prescription drug coverage is also not included in Original Medicare. You would need to purchase a separate Part D plan to cover medications.
Medicare Advantage
Medicare Advantage (also known as Part C) is an alternative to Original Medicare offered through private insurance companies approved by Medicare. These plans combine Part A and Part B and often include Part D prescription drug coverage.
Additionally, many Medicare Advantage plans offer extra benefits like dental, vision, hearing, and even gym memberships.
However, Medicare Advantage plans generally require you to use a network of doctors and hospitals. This means if you choose a Health Maintenance Organization (HMO) plan, for example, you’ll need to see in-network providers to have your care covered (except in emergencies).
Key Considerations in Medicare vs Medicare Advantage
Original Medicare and Medicare Advantage differ in several ways. And knowing their specifics can help you make a good choice. Below are some key considerations you should know.
Cost
With Original Medicare, you pay a monthly premium for Part B, and if you want prescription drug coverage, you’ll also pay a premium for Part D. Out-of-pocket costs, such as coinsurance, can also add up.
Medicare Advantage plans often have lower upfront costs, with some offering $0 premiums. However, you might have higher copayments or coinsurance for services, depending on your plan’s structure.
Coverage
Original Medicare covers most medically necessary services like hospital and medical insurance, but not things like routine dental and vision. On the other hand, Medicare Advantage plans can include additional benefits such as dental, vision, and wellness programs.
Flexibility
Original Medicare allows you to see any doctor who accepts Medicare, which provides great flexibility. This is an advantage for those who see multiple specialists or travel frequently.
Medicare Advantage plans typically require you to stick to a network of providers, which can limit your choices but may offer integrated care and lower costs.
Which Option is Right for You?
The choice between Medicare vs. Medicare Advantage depends on your personal needs. If you value flexibility and want the freedom to see any doctor without network restrictions, Original Medicare might be the best fit.
However, if you're looking for a more comprehensive, all-in-one plan with additional benefits and lower upfront costs, Medicare Advantage could be the way to go.
As you approach your Medicare enrollment period, which begins three months before you turn 65 and ends three months after your birthday month, you should assess your healthcare needs to make the best choice.