Original Medicare is a safety net, but does not pay 100% of charges incurred for covered services. In addition, Medicare doesn't offer coverage for other services such as routine dental, hearing and vision. Cost sharing with original Medicare includes hospital deductibles, co-pays and co-insurance for outpatient services. Medicare beneficiaries often say that they just cannot afford the 20% that Medicare does not pay. Of course they are referring to the outpatient co-insurance.
When comparing these two options, Medicare Part C offer:
When comparing these two options, Medicare Part C offer:
- Co-pays for many covered services, such as doctor's visits, testing and emergency room visits.
- Part D drug coverage is often included in a Plan C, potentially resulting in some cost savings.
- Advantage Plans often include coverage for additional services not covered by Medicare, such as; dental, vision, hearing and sometimes even health club memberships.
- Some people with special needs may find Advantage Plans more focused on their individual situation.
- Advantage Plans offer beneficiaries an annual maximum out-of-pocket amount. With Medicare your amount of cost sharing is not capped on an annual basis and with an Advantage plan, if you reach a certain thresh hold, you will have your costs covered 100% for covered services.
Medicare Advantage vs. Medicare supplement insurance :
Medicare supplement insurance policies have been around for about 40 years. As you know, an insurance company receives a premium in return for filling in the gaps that original Medicare does not pay on covered services.
Not everyone can qualify for a Medicare supplement and an Advantage Plan may be the solution. Reasons a supplement may not be feasible include:
- The premiums for a supplement are not affordable.
- The beneficiary is dual eligible, qualifying for both Medicare and Medicaid, and as such, doesn't qualify for a supplement.
- The beneficiary may have missed the guaranteed enrollment period for a supplement and cannot qualify medically due to the policies underwriting requirements.
Medicare Advantage vs. employer group insurance :
Many people who become eligible for Medicare are able to maintain coverage through the former employer or are still employed. Having insurance in this situation is often seen as a benefit in return for the years of service with that employer.
Often, those eligible for coverage will opt out and choose an Part C. Some reasons for doing so may include:
- The premiums required for the employer plan are not affordable.
- Deductibles, co-pays and co-insurance may be considerably more than what could be had with an Advantage Plan.
- The employers plan does not offer coverage as comprehensive as an Advantage Plan,
- The employers plan may be restrictive in its network and not meet the needs of the retiree who wants more flexibility.
- The beneficiary may find that due to the employer's volatility in the current economic climate, it's uncertain for how long the benefit will be available and the beneficiary wants some certainty.
It's your choice
There are many reasons that you may choose an Advantage Plan over other options available. Ultimately, you need to weigh your options, and armed with knowledge make your best choice.
