Pros and Cons of Medicare Advantage Plans vs. Original Medicare

As you approach your 65th birthday, your thoughts are likely focused on a well-deserved retirement in a sunny spot of your choosing. After years of gainful employment, you deserve a break, but there’s still one more important thing you need to figure out.

Growing older usually comes with unavoidable healthcare expenses. Medicare can help you pay some of these costs, although 51% of people with Medicare still find it difficult to afford healthcare expenses.

Because of this, it’s vital to make the right choice when it comes to choosing the best plan for you.

You have a limited window of opportunity to make the right choice between Medicare Advantage Plans or Original Medicare. Read on for a side-by-side comparison of the two to help you decide.

Medicare Advantage Plans vs. Original Medicare: The Basics

Every US citizen over the age of 65 qualifies for Medicare, as well as people under 65 who have end-stage renal disease or disabilities.

People who receive Social Security payments are automatically signed up for Medicare. Everyone else can opt out of this medical insurance if they prefer.

Either way, it’s important to consider all your options before you commit, as it’s complicated to make changes afterward.

Original Medicare has three parts, namely Parts A, B, and D. You pay different monthly premiums for each of these. Medicare Part C comprises a wide variety of Medicare Advantage plans offered by private insurers.

Medicare Advantage Plan Features vs. Original Features

Each Medicare plan offers a fixed set of government-prescribed benefits.

Medicare Advantage plans must meet restrictions and standards set out by Medicare. After that, they make their own rules about extra services.

Medicare covers the following medical services, depending on which part you choose:

  • Part A (hospital insurance) pays for inpatient hospital stays, some home health care, and nursing facility care
  • Part B (medical insurance) covers some medical supplies, doctor’s services, outpatient care, and preventive care
  • Part D helps patients pay for vaccines and the cost of prescription drugs

Part C Advantage plans include Part A, B, and D, plus a bouquet of services peculiar to each plan. Most Advantage Plans offer vision, dental, and hearing care benefits.

If you opt for Medicare Original, you can choose whether you want to add Part B and D to your Part A insurance.

Medicare Advantage Plans vs. Original Costs

Most people don’t pay a premium for Part A of Original Medicare. That’s because they’ve worked for more than 10 years and paid Social Security taxes every month.

Those who don’t receive premium-free Part A can expect to pay $505 every month for this part of Medicare in 2024. Everybody who signs up for Medicare Part B will pay $174.70 per month for these benefits in 2024.

Part C premiums include the costs for Parts A and B, plus all the other benefits included in your plan. These plans can cost anywhere between $0 and $200 extra.

Part D plans offer varied premiums, averaging around $55.50 per month for 2024.

Medicare Advantage Plans vs. Original Drug Coverage

In most cases, your Medicare Advantage premiums include prescription drug coverage. With Medicare Original, you must buy a separate Part D plan to qualify for this benefit.

Both the Medicare Original and Advantage plans have restrictions on the types of drugs they cover as well as the dosage. Don’t overlook this vital part of your medical care; some seniors pay over $6,000 per year just for prescription drugs

Medicare Advantage Plans vs. Original Networks

Most healthcare providers accept Medicare insurance, apart from a few linked solely to military insurance providers.

Your options are more limited with Medicare Advantage Plans. These plans offer six different ways to get you the healthcare you need:

HMO (Health Maintenance Organization)

These plans usually include medication coverage, but you’re limited to receiving care from a defined network of providers. If you get assistance outside of the network, your insurer won’t cover any of your expenses.

PPO (Preferred Provider Organization)

These plans also include prescription medication coverage and apply to a select network of providers. When you receive treatment from a preferred provider, you’ll pay less out of pocket than when you visit an out-of-network provider. 

PFFS (Private Fee-for-Service)

PFFS plans are highly variable and may or may not stipulate network-based providers. When you opt for this plan, you must receive treatment from an out-of-network provider who accepts Medicare reimbursement.

These plans include numerous terms and conditions. They don’t often include prescription medication coverage.

SNP (Special Needs Plan) 

These plans suit people with chronic ailments like diabetes, especially if they qualify for both Medicaid and Medicare. All SNPs must provide Medicare prescription medication coverage.

MSA (Medicare Medical Savings Account) 

These high-deductible plans offer a dedicated savings account for medical expenses and prescription medication coverage. When you opt for this type of plan, you pay money into this savings account every month.

HMO-POS (HMO Point-of-Service)

These hybrid HMOs allow you to go outside your network for treatment, provided you’re willing to pay more for that care. There are separate deductibles for in-network and out-of-network charges. Prescription medication coverage is generally included.

Medicare Advantage Plans vs. Original Benefits

The best benefit of health insurance is avoiding unexpected medical bills, yet few plans cover all your expenses. You must review things like deductibles and out-of-pocket costs when deciding on the best plan for you.

Medicare Original is widely accepted across the country. Medicare Original has no cap on out-of-pocket expenses, but you can take out Medigap insurance to cover these costs.

Supplemental Medigap insurance is a good option for travelers, as some of these plans offer international coverage.

Medicare Advantage plans are usually cheaper than Medicare plans and may offer more benefits. They usually cap out-of-pocket expenses at $8,000 for the year.

Unfortunately, Medicare Advantage plans are only accepted within limited networks. This can detract from the other benefits offered.

Get Help Choosing the Best Plan For Your Needs

Take your time choosing the best plan to suit your needs. You don’t get a lot of opportunities to change your mind without attracting penalties or increased fees.

Do you need help comparing Medicare Advantage Plans vs. Original Medicare in the context of your situation? Our professional staff offers expert, bilingual guidance to help make the best choice for your needs. Let’s make sure you get the insurance coverage that you deserve!