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  • Writer's pictureMike Layden, CPA

Original Medicare vs Medicare Advantage Springfield, IL

Updated: Jun 3

Authored by Mike Layden, CPA who is a Medicare Broker and Advisor with Health & Life Solutions, Inc. in Springfield, IL.  He has over 30 years of financial management experience. He has been married for 22 years.  He is a US Army veteran and served in Operations Desert Shield and Storm.  He can be reached at (217) 290-1768 or info@HealthandLifeSolutionsInc.com.


Introduction

Are you nearing the age of 65 and preparing to navigate the world of Medicare? Understanding your healthcare coverage is critically important to make an informed choice to ensure you receive the care you need. In this article, we will compare the two main types of Medicare coverage: Original Medicare and Medicare Advantage. You can make the best choice for your healthcare needs and financial situation by exploring all available coverage options.


Key Takeaways

  • Medicare offers different options for healthcare coverage, including Original Medicare and Medicare Advantage

  • Understanding the differences between these options is crucial to make an informed choice

  • Original Medicare is the traditional fee-for-service program, while Medicare Advantage is an alternative offered by private insurance companies

  • Original Medicare provides coverage for hospital stays, doctor visits, and medical services, while Medicare Advantage often includes additional benefits

  • Consider your preferences, budget, and anticipated healthcare needs when choosing between Medicare options


Understanding Medicare Advantage vs Original Medicare Options

As you approach Medicare eligibility, it's important to familiarize yourself with the different options available. Medicare offers various types of coverage, including Original Medicare and Medicare Advantage plans. Making an informed choice about your healthcare coverage is crucial for your well-being. By understanding the differences between Original Medicare and Medicare Advantage, you can make the right coverage choice that suits your needs.


Medicare options refer to the different ways you can receive healthcare coverage through the Medicare program. The two main options are Original Medicare and Medicare Advantage. Original Medicare consists of Part A (hospital insurance) and Part B (medical insurance). It provides coverage for hospital stays, doctor visits, and medical services. On the other hand, Medicare Advantage, also known as Medicare Part C, is an alternative to Original Medicare. It is offered by private insurance companies approved by Medicare.


One key difference between Original Medicare and Medicare Advantage is the way healthcare providers are chosen. With Original Medicare, you have the freedom to choose any healthcare provider who accepts Medicare assignment. Medicare Advantage plans often have more limited networks and may require you to choose from a network of preferred providers. Understanding this difference is crucial, as it impacts your doctor and hospital choices.


It is important to take the time necessary to understand your Medicare options. By doing so, you can make the right coverage choice that suits your healthcare needs and preferences. It's essential to consider factors such as coverage, costs, doctor choices, and additional options like Medigap plans. Keep reading to explore the specifics of Original Medicare and Medicare Advantage to determine which option is best for you.


Exploring Original Medicare

Original Medicare is the traditional fee-for-service healthcare program that has been in place for decades. It consists of two main parts: Medicare Part A and Part B. Medicare Part A provides coverage for hospital stays. Medicare Part B covers medical services such as doctor visits and outpatient care.


With Original Medicare, you have the freedom to choose your healthcare providers, as long as they accept Medicare assignment. This allows you to see any doctor or specialist who participates in the Medicare program. You do not need referrals to see specialists, giving you more flexibility in managing your healthcare.

Some individuals choose to enroll in a Medicare supplement insurance plan to reduce the costs provided by Original Medicare. They also enroll in a separate Medicare drug plan. These plans can help cover the gaps in Original Medicare coverage, providing peace of mind that comes from financial protection.


Understanding how Original Medicare works is crucial in making an informed decision about your healthcare coverage. Once you understand Original Medicare, you will navigate Medicare with confidence. Understanding Original Medicare includes choosing doctors, and whether you need additional coverage through Medigap plans.


Delving into Medicare Advantage

Medicare Advantage, also known as Medicare Part C, is an alternative to Original Medicare and offered by private insurance companies. These companies are approved by Medicare. There are many Medicare Advantage plans to choose from with benefits that vary by plan. Medicare Advantage plans are designed to provide all-in-one coverage. These plans often including additional benefits beyond what Original Medicare covers, such as prescription drug coverage, dental, vision, and hearing benefits.


You still receive all the benefits of Original Medicare when you enroll in a Medicare Advantage plan. The difference is that your medical care is managed through the private insurance company providing the Advantage Plan.


Medicare Advantage plans can be an appealing option if you desire additional benefits beyond what Original Medicare offers. You will learn which plan is best for you by exploring the available benefits and network limitations of Medicare Advantage plans.


Coverage Differences

One of the key considerations when choosing between Original Medicare and Medicare Advantage is the coverage differences. Original Medicare has a broad network of providers nationwide, allowing you to see any provider that accepts Medicare assignment. This flexibility is advantageous, especially if you have specific healthcare needs or prefer to work with certain healthcare providers.


On the other hand, Medicare Advantage plans typically have more limited networks. This means you may be required to choose from a network of preferred providers when seeking healthcare services. Some Medicare Advantage PPO plans offer out-of-network coverage. It is important to understand the limitations and potential additional costs associated with going outside the network. Being aware of the coverage differences ensures that you make the right choice for your healthcare preferences and needs.


Cost Comparison

When deciding between Original Medicare and Medicare Advantage, the cost is an important factor to consider. Medicare Part A has a deductible that is charged per benefit period. For 2024, this deductible amount is $1,632. A benefit period starts on the day you enter a hospital for care. It ends when you have been out for 60 consecutive days. During this time, you may be in the hospital more than once. The first 60 days in the hospital there is no copay required from you. However, from days 61-90, there is a daily copay amount of $408.


Original Medicare has standard premiums for Part B coverage, as well as deductibles and -coinsurance costs. The premiums are typically deducted from your Social Security benefits, and the deductibles varies from year to year. The biggest cost risk is the 20% Part B coinsurance. Medicare pays 80% of eligible expenses and you pay the other 20%. Keep in mind, this 20% is unlimited. So, the sky is the limit on your share of Part B coinsurance. One major catastrophic illness or accident could easily wipe out a nest egg that you saved all those working years.


Medicare Advantage plans often have different cost structures. While some plans have lower premiums than Original Medicare, they may have higher copayments and coinsurance. It's crucial to carefully review the costs associated with each option and consider your budget and financial resources. Medicare Advantage plans are pay as you go. One of the benefits is that each Advantage plan has a set maximum out of pocket. So, these plans do help to limit out of pocket expenses over Original Medicare.


Comparing Original Medicare costs and Medicare Advantage will help you determine which option aligns with the healthcare services you need. By conducting a cost comparison, you can make a financially sound decision that suits your individual circumstances.


Doctor and Hospital Choices

Choosing the right doctor and hospital is an important aspect of your healthcare coverage decision. With Original Medicare, you have the freedom to see any doctor or hospital that accepts Medicare. This allows you to choose healthcare providers based on your personal preferences and needs.


In contrast, Medicare Advantage plans may have a network of preferred providers that you must choose from. When selecting a primary care physician within the network, you may receive coordinated care and additional benefits. However, accessing healthcare services outside the network may involve additional costs or not be covered at all.


Furthermore, Original Medicare allows you to see specialists without referrals, providing more autonomy in managing your healthcare. Medicare Advantage plans may require you to obtain referrals for certain specialists, which can add additional steps prior to treatment.


Considering your preferences for doctor and hospital choices is essential in your coverage decision. If having the freedom to see any healthcare provider is important to you, Original Medicare may be the preferred option. However, if coordinated care and access to additional benefits are appealing, a Medicare Advantage plan may be a better fit.


Medigap Options

Original Medicare coverage is required if you wish to purchase a medigap plan. These plans help to pay for certain healthcare costs that Original Medicare doesn't cover. These plans are sold by private insurance companies and can provide additional peace of mind and financial protection.


Medigap plans cover various expenses, such as deductibles, coinsurance, and sometimes even foreign travel emergency care. There are several standardized Medigap plans available, labeled Plan A through Plan N, each offering different levels of coverage. A Medicare Supplement Plan G is estimated to cost $125 monthly. In addition, you will be responsible for the Medicare Part B deductible of $240.00 in 2024. But that is it. Medicare and the Medigap provider will pay all other eligible Medicare expenses.


Understanding the different Medigap options available is crucial in making an informed choice about your healthcare coverage. You can select the best coverage option by weighing the pros and cons of each coverage option. The pros and cons need to address your unique health situation and estimated out-of-pocket costs.


Making the Best Medicare Coverage Choice for You

When it comes to choosing between Original Medicare and Medicare Advantage, there is no one-size-fits-all answer. Making the best choice for your healthcare coverage ultimately comes down to your personal preferences, needs, and financial resources.


Consider your current health conditions and anticipated healthcare needs. If you have ongoing medical conditions or require specific medical services, Original Medicare may provide the flexibility and coverage you need. However, a Medicare Advantage plan may be more suitable for you if you're seeking additional benefits and coordinated care.


Evaluate your budget and financial resources when choosing between Medicare options. The best decision is possible when you understand the costs associated with each option, including premiums, deductibles, and out-of-pocket expenses.

Lastly, seek guidance from a trusted healthcare professional or Medicare expert. They can provide personalized advice based on your unique circumstances and help you navigate the complexities of Medicare.


Other factors that impact your choice includes your healthcare needs and budget.


Conclusion

In conclusion, understanding the differences between Original Medicare and Medicare Advantage is crucial when making the right coverage choice. You will make informed decisions about your healthcare coverage when you take the following into account:


1. Coverage differences,

2. Costs,

3. Doctor choices, and

4. Additional coverage through Medigap plans.


Remember to evaluate your personal preferences, budget, and anticipated healthcare needs to ensure you choose the best option for you.


So, now that you have a better understanding of Original Medicare and Medicare Advantage, which option resonates with you? Are you more inclined towards the flexibility of Original Medicare or the added benefits of Medicare Advantage? Share your thoughts and join the conversation!


Key points summary:

  • Medicare offers different options for healthcare coverage, including Original Medicare and Medicare Advantage

  • Original Medicare is the traditional fee-for-service program, while Medicare Advantage is an alternative offered by private insurance companies

  • Original Medicare provides coverage for hospital stays, doctor visits, and medical services, while Medicare Advantage often includes additional benefits

  • The coverage differences, costs, doctor choices, and Medigap options are important factors to consider when making a coverage choice

  • Personal preferences, anticipated healthcare needs, and financial resources should guide your decision-making process


Frequently Asked Questions


What is the difference between Medicare Original and Medicare Advantage Plan?

Medicare Original is the traditional fee-for-service program run by the federal government. Medicare Advantage Plans are offered by private insurance companies approved by Medicare. Original Medicare allows you to see any doctor or hospital that accepts Medicare. Medicare Advantage Plans often have networks of providers you must use.


What extra benefits are available in Medicare Advantage and not in Original Medicare?

People may choose Medicare Advantage for additional benefits not covered by Original Medicare. These additional benefits may include dental, vision, and prescription drug coverage. Medicare Advantage Plans may also have lower out-of-pocket costs and include care coordination services.


Why are people leaving Medicare Advantage plans?

Medicare Advantage plans and the benefits and limitations may change on an annual basis. Therefore, some people may choose to exit a plan because it no longer is the best fit for them. Others may find that Original Medicare offers more flexibility and choice in healthcare providers.


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