While the extra benefits packaged into Medicare Advantage plans at little or no additional plan premium may seem enticing, seniors need to carefully consider what they are exchanging when they engage this type of plan to manage their Medicare benefits. If you have to engage some of the most important pieces of your Medicare benefits, you may wish you had instead chosen Traditional Medicare (aka Original Medicare). So, let’s compare Traditional Medicare to Medicare Advantage plans and see what might be the best fit for you.
What is it?
Traditional Medicare consists of Part A (hospital insurance) and Part B (medical insurance).
Traditional Medicare offers a wide network of healthcare providers, giving beneficiaries the flexibility to choose their doctors and specialists.
Freedom from Referrals and Prior Authorization (No Gatekeepers):
With Traditional Medicare, you generally don't need referrals to see specialists, and there are no prior authorization requirements for most services. This can be advantageous when seeking specialized care or therapy.
Access to Senior Rehabilitation:
Traditional Medicare covers senior rehabilitation services such as physical therapy, occupational therapy, and speech therapy when medically necessary after an accident, injury, or illness. Coverage is generally available in any approved healthcare facility that you choose, like the Rehab Inn at Wesley Place on Honeysuckle.
Traditional Medicare offers nationwide coverage, making it suitable for seniors who may travel frequently, have out of state adult children who may want parents close when extra care is needed, or those who have secondary residences in other states.
While Traditional Medicare provides comprehensive coverage and allows you the freedom to choose your own doctors, specialists, hospitals, and more, it does come with some cost-sharing requirements. Beneficiaries may need to pay deductibles, coinsurance, and premiums for Part B and potentially purchase additional coverage like Medigap to help with these expenses.
MEDICARE ADVANTAGE PLANS
What is it?
Medicare Advantage plans, often referred to as Part C, bundle together hospital (Part A) and medical (Part B) coverage, along with additional benefits like vision, hearing, and prescription drug coverage. Medicare Advantage plans manage Medicare benefits.
Medicare Advantage plans typically have restricted provider networks. Beneficiaries may be required to use in-network doctors and hospitals, which can be limiting for those who prefer specific healthcare providers. This may also limit your choice of rehabilitation providers. Plus, it is possible that your doctor or preferred hospital this plan year will not be in the network the next plan year, so you may be forced to change plans or change providers for your treatment to continue to be covered.
Prior Authorization and Referrals (Gatekeepers):
Medicare Advantage plans often require prior authorization and referrals for certain services, including specialized therapies. This may lead to delays in accessing rehabilitation services.
Some Medicare Advantage plans may have limited coverage outside their service areas, making them less suitable for seniors who frequently travel, have out of state adult children they may have wanted to recuperate near, or those who have homes in different regions.
Medicare Advantage plans usually have a cap on out-of-pocket expenses, providing beneficiaries with cost predictability and potentially lower overall costs compared to Traditional Medicare plus supplemental plans.
When deciding between Traditional Medicare and a Medicare Advantage plan, seniors should consider their individual healthcare needs, budget, preferred healthcare providers, and lifestyle factors. Traditional Medicare offers much more freedom, choice and flexibility, but it comes at a higher out-of-pocket cost. By contrast, Medicare Advantage plans provide some additional benefits with little or no additional plan premium, but may limit your choices when it comes to the doctor, hospital or rehabilitation center you want to use. Consulting with a Medicare counselor or insurance agent can help seniors make an informed choice based on their unique circumstances and preferences. But your decision should be well thought out, and should align with your healthcare priorities and financial situation.