Medicare vs. Medicare Advantage:

Which Plan is Right for You?

Medicare plans are not one-size fits all, and finding the one that meets your needs can be a daunting task.Standard Medicare comes in two parts: Part A and Part B. Part A, which requires no premium, covers a portion of hospitalization expenses. Part B, which does require a monthly premium, covers doctor bills and other medical expenses such as lab tests and some preventive screenings. But some seniors find that Medicare Part C, or a Medicare Advantage plan, better covers their health care needs. Medicare Advantage plans are offered by private insurance companies and must offer coverage that is comparable to Medicare Part A and Part B. Most also include prescription drug coverage, which is available under Part D with traditional Medicare
Medicare Advantage may be right for you if:
  • You take prescription drugs. Most Medicare Advantage plans cover prescriptions, whereas you'll have to purchase Part D to receive the same coverage with Medicare.
  • You want a cap on your out-of-pocket spending. Medicare Advantage has, by law, an out-of-pocket maximum of $6,700. Once you reach that limit, all of your expenses will be covered. Medicare has no out-of-pocket maximum, so you will keep paying for a portion of services as you use them.
  • You want an alternative to enhancing your Medicare coverage with private Medicare Supplement (Medigap). Some, though not all, Medicare Advantage policies are better at closing the coverage gap than adding Medicare Supplement to traditional Medicare.
  • You want an alternative to the 20% coinsurance charged by Medicare for most services. Medicare Advantage plans are structured differently, and offer lower (or higher) coinsurance or may charge a copay instead. The trade-off may be a higher monthly premium.
  • You want coverage for vision, dental, assisted living facilities, or nursing home care. Certain Medicare Advantage plans will cover these services.
Traditional Medicare may be right for you if:
  • You want the broadest choice of doctors and medical providers. More medical professionals accept Medicare than Medicare Advantage.
  • You can't afford or don't want to pay an additional premium. You'll have to pay a premium for the Part A portion of Medicare Advantage.
  • You want maximum flexibility when choosing medical specialists. With Medicare, you don't need authorization from a primary care doctor to see a specialist. Medicare Advantage plans that are designated HMOs may require you to see a primary care doctor first, and PPO plans will charge you more if you see an out-of-network provider.
  • You're employed and covered by your employer. You may end up paying an unnecessary premium with Medicare Advantage or could lose your employer-sponsored coverage.
  • You have employer-sponsored retiree benefits that supplement Medicare. You can't use these benefits with Medicare Advantage.
  • You qualify for Medicaid or Medicare Savings Program. Low-income beneficiaries have other options, and you should contact your state Medicaid office.

Medicare Supplement
Medicare Advantage

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