Traditional Medicare vs. Medicare Advantage Plans: Look before You Leap

Linda was turning 65 in three months, and it was time to enroll in Medicare. She thought it would be a relatively simple process but soon discovered that making this decision was not that easy. There were original Medicare Parts A and B, Part D for prescription drug coverage and Part C plans, also known as Medicare Advantage plans. Then there was Medigap, a supplemental private insurance plan that covers services that original Medicare doesn’t. Linda began to feel a little overwhelmed as she sorted through what seemed like a mountain of information.

Which Medicare plan best meets your needs? Choosing the right plan requires careful consideration of the many options available. For example, plans vary in cost, provider networks, coverage types and levels, and maximum out-of-pocket expenses. Traditional Medicare Parts A and B generally cover inpatient care in a hospital, skilled nursing facility care (but not long-term care), hospice and home health care. Part B covers preventive and medically necessary services, and Part D covers prescription drugs. However, services not covered by traditional Medicare include vision, dental, and hearing care. The official open enrollment period is October 15 through December 7.

Medicare Advantage plans, offered by private insurers approved by the federal government, must provide the same benefits offered by original Medicare but may have different rules, costs, and restrictions. On the plus side, Medicare Advantage plans may offer benefits not covered by Medicare, such as vision and dental services, and may cost less in the long run. However, while original Medicare covers you if you see any doctor or facility that accepts Medicare, most Medicare Advantage plans generally limit you to doctors within an HMO or PPO network and may or may not cover out-of-network care. This can be problematic for people who travel.

Each person’s situation is unique, and it’s important to be as informed as possible before making the decision between original Medicare or a Medicare Advantage plan. It can be very helpful to speak with your doctor, consult with a geriatric care manager and a licensed insurance agent, and research what Medicare plans cover on Medicare.gov. You may also contact Medicare at 1-800-MEDICARE (1-800-633-4227). There is an option to compare plans at Medicare.gov’s plan finder.

Fortunately, if you decide you’ve made the wrong choice, you can switch from a Medicare Advantage plan to original Medicare between January 1st and March 31st each year.

If you need assistance and live in the Sarasota, Bradenton, area of Florida, please reach out to us and we’ll be happy to help. We can be reached at 941-444-8760 or LinkedIn | Facebook.