When it's time to select a Medicare plan, the options can be overwhelming. The first step is to choose between original Medicare and Medicare Advantage. There are many benefits and pitfalls for each option. Your income and medical needs can often be a deciding factor.
Routine Costs
Your routine costs will be the monthly premium and the amount you pay for various medical services. Both original Medicare and Medicare Advantage will require a monthly premium for your insurance. A major difference between the two plans is the total amount you will pay out-of-pocket for medical services. For original Medicare, once you reach your deductible, you will pay a certain percentage of coinsurance for the remainder of the insurance year. With Medicare Advantage, there's a cap on the amount you have to pay out-of-pocket each year. If you surpass the cap, your services will be free for the remainder of the insurance year. People who are low-income generally have their out-of-pocket costs for original Medicare covered by enrolling in Medicaid.
Additional Services
Prescription drug benefits and additional services like dental, hearing, and vision can be critical for most people enrolled in Medicare. There is a significant difference in what is covered between the two types. Generally, none of these services are covered by original Medicare. The number of additional services covered by Medicare Advantage may vary. Prescription drugs should be covered by Medicare Advantage, but there is some variation in whether dental, hearing, and vision are covered and the rate at which it is covered. If you choose original Medicare, you will need to purchase a separate plan for medication coverage and additional services.
Provider Flexibility
Original Medicare tends to be more flexible in terms of the providers you can see than Medicare Advantage. If you travel, original Medicare will allow you to see any provider that takes Medicare. Medicare Advantage requires you only see providers in their network if it's non-emergency care. Although this may not seem like a significant issue, if you are in another location and experience a non-emergency health issue, it will be far less expensive for you to make an appointment with a local provider or urgent rate, rather than use the emergency room because it's the only service covered. Another difference is original Medicare does not require a referral to see a specialist, whereas you must get a referral if you have Medicare Advantage. This can be a critical difference for people who have chronic and/or serious health issues but are having a hard time getting an appropriate referral from their primary doctor.
Deciding between original Medicare and Medicare Advantage is difficult and can make a significant difference in your out-of-pocket expense for medical care. Taking into consideration the differences between each type can help you find the option that is most cost-effective while giving you the best services for your needs.
For more info, contact a local company like Active Medicare Solutions.