Yes indeed, I fall squarely in the “sandwich” generation. Caring for a growing kid and parent long distance at the same time. I suspect many people can relate and, like me, want only the best for our family members.
In caring for our older relatives and friends, the world of health care such as Original Medicare vs. Medicare Advantage can be particularly perplexing. Because of that, I have put together bullet point information to summarize important points about the two.
I want to make it clear right off the bat that I am no expert on medical insurance plans. Just an average time-crunched individual trying to do right by my parent. Before, you enroll in any plans, get advice based upon your individual situation from a Medicare expert.
Original Medicare Vs. Medicare Advantages Summary
Medicare serves as a federal health insurance program largely for people who are 65 or older, with some exceptions for younger individuals (Medicare.gov).
- When an individual first enrolls in Medicare and during annual enrollment periods, he or she can select between Original Medicare and Medicare Advantage.
- If Original Medicare is selected, Part A (Hospital Insurance) and Part B (Medical Insurance) are administered by the federal United States government. In addition, enrollees can choose to purchase Prescription Drug Coverage (Part D) and/or a supplement (Medigap) from a private insurance company. It is not required to get this additional coverage, but it is highly recommended.
- If Medicare Advantage is selected, a private company administers Part A, Part B, and often a Part D plan. Medigap coverage is not available with these plans.
Original Medicare Strengths
- See any doctor that accepts Medicare (and has availability for new patients). No referral is needed from another physician. For people who travel often or want max freedom of choice, big plus.
- Certain costs tend to be more well-defined up front.
- Allowed to buy Medigap plan to help pay out-of-pocket costs.
Original Medicare Weaknesses
- No yearly cap on what a person may have to pay out-of-pocket. Thereby, the great importance of carrying a Medigap policy. Enrollment in this policy is only guaranteed under certain conditions.
- Separate enrollment for Part D and Medigap if desired.
Medicare Advantage Strengths
- With these plans, Part A, Part B, and often Part D, are conveniently bundled together.
- Yearly caps on what enrollees pay for Medicare Part A and Part B services exist. Low premiums found with some plans.
- Additional benefits not offered by Original Medicare such as basic vision, hearing, and dental coverage may be available.
Medicare Advantage Weaknesses
- Will need to use a defined network of physicians for coverage or max benefits.
- Referral often needed to see specialists and for a variety of services.
- You cannot use Medigap coverage to help pay for out-of-pocket expenses.
How To Choose
Look carefully at individual current health and financial situations, Also, consider what future health and finances may look like.
- Does the person have a chronic illness now or a strong genetic family history that may indicate potential problems down the road? According to the U.S. Government Medicare Handbook, in general, the best time to buy a Medigap policy is during the 6-month period which starts on first day of month in which 65 or older and enrolled in Medicare Part B. After that enrollment period, “you may not be able to buy a Medigap policy. If you are able to buy one, it may cost more”.
Take my parent as a good example of why this information about Medigap Policies matters so much. He has Parkinson’s and has been on a Medicare Advantage Plan for some time. As more skilled care is required, he has been receiving increasing denials of service.
He would like to switch back to Original Medicare and have a Medigap policy to cover a number of out-of-pocket expenses. His chances of getting approved for a Medigap policy now with his Parkinson’s are not good.
- Does the individual need more predictable monthly premium and out-of-pocket costs or is there some flex in the budget? From what I can tell (again NOT AN EXPERT, CONSULT ONE) Original Medicare with Part D and Medigap Coverage may offer more month to month predictability than Medicare Advantage. The trade off here is that some Medicare Advantage plans may save you up front in lower overall premiums and extra benefits.
- Is the person a homebody or do they travel often? Frequent travelers could benefit from greater provider choice, while for a homebody this might not be such an issue.
Where to Find Expert Help When Selecting Plans
Private insurance providers of Medicare Part D (Prescription Plans), Medigap Plans, and Medicare Advantage Plans vary by state. Start with the Medicare.gov website. This official U.S. Government website offers search features to explore drug and health plans by zip code.
Additionally, at the Medicare.gov site, find recommended expert help resources for your particular state.
If you are still unsure or feel overwhelmed, it may be a good time to consult with reputable health insurance broker in the state of enrollment. Reputable brokers should be in good standing with watchdog groups such as the Better Business Bureau, and have a good reputation among fellow community members. Also, they should offer plans from multiple companies.
The right health insurance brokers can provide valuable guidance.
I hope that you have found this information about Original Medicare and Medicare Advantage helpful and time saving. Knowledge is definitely power when it comes to making health care plan decisions.
For more Money Saving Tips:
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