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When you become eligible for Medicare, choosing whether you get your Medicare benefits from Original Medicare or Medicare Advantage can be complicated. You may be wondering: "What is the best Medicare plan?" However, there really isn’t a “best” plan – there is only the best plan for your needs. So, how do you decide? First of all, make sure you learn about the different parts of the Medicare program, then assess your health and budget, and finally, take advantage of a Medicare agent’s expertise to help you decide if a Medicare Advantage plan is right for you. To help you with your needs assessment and “Original Medicare vs. Medicare Advantage” debate, ask yourself the following questions as you navigate your options.
Can I afford any surprise medical expenses?
With a Medicare Advantage plan, when you reach your plan's maximum out-of-pocket limit, your insurance plan will pay 100% of the additional covered charges incurred in the remaining calendar year. However, Original Medicare does not have an out-of-pocket limit. This means your out-of-pocket expenses may continue for as long as you require treatment. Not having an out-of-pocket limit can introduce some uncertainty into your healthcare budget.
Would a smaller network of doctors affect my treatment options?
Medicare Advantage (MA) plans contract with a specific network of providers, therefore you may have a more limited choice of doctors and providers in your zip code. When you choose Original Medicare, you may visit any provider who is approved by Medicare and accepts assignment, so depending on where you live, you may have access to a larger selection of providers than a Medicare Advantage network. However, even with Original Medicare, you’re not guaranteed access, if say, the doctor’s practice is full. If you want to have access to a specific doctor, check that your preferred doctor belongs to the network of the Medicare Advantage plan that you’re interested in before you enroll.
What is most convenient?
Medicare Advantage’s suite of coverage may be attractive to those seeking an all-in-one plan that requires just one simple card. Medicare Advantage plans can cover additional benefits or services that Original Medicare doesn’t cover, such as vision, hearing, dental, or health and wellness programs. In addition, the plan may include prescription drug coverage (Part D). Medicare Advantage plans also provide all of the Part A and Part B benefits of Original Medicare. On the other hand, if you have Original Medicare and want additional coverage, you may find yourself juggling multiple plans and cards. For example, you will need to purchase your Part D prescription drug coverage separately. And if you select Original Medicare and need supplemental insurance (Medigap) to help pay for costs Original Medicare doesn’t cover, you will need to purchase a separate policy as well.
How do I want to get my prescription drug benefits?
Original Medicare does not include prescription drug benefits in its part A and part B coverage. However, you can add Part D coverage by enrolling in a private "stand-alone" drug plan for an additional premium. Many Medicare Advantage plans include Part D prescription drug coverage. When choosing between Medicare Advantage or Original Medicare, it may help to consider how much you currently rely on medications and how that could change in the future. If you do not sign up for Part D coverage when you are first eligible, you may incur a late enrollment penalty if you decide to enroll later on.
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Last Revised 11/15/2017