Medicare vs. Medicare Advantage Plans - Rodgers & Associates

Medicare vs. Medicare Advantage Plans

It’s that time of year again. Medicare open enrollment runs from October 15th until December 7th each year. If you are new to Medicare, there are many decisions to be made. If you are already enrolled, health plans and prescription drug coverage can be evaluated for the following year to better meet your needs.

Here’s a look at coverage differ­ences between Medicare and Medicare Advantage, along with the pros of each plan. What you choose will depend on your needs, but now is the time to weigh your options and make changes if needed.

Original Medicare Covers:   

Part A – Hospital Insurance

Part B – Medical Insurance

Part D – Prescription Drugs (stand alone, from private insurance companies and additional premium)

Medicare Supplement Insurance (called ‘Medigap’) (from private insurance companies and additional premium)

Medicare Advantage Plans Cover:

Part C (like an HMO or PPO) – Combines Part A, Part B, and usually Part D

Pros of Original Medicare:

  • Coverage is accepted by any doctor or hospital in the nation that accepts Medicare.
  • Additional out-of-pocket costs are minimal once a Medicare Supplement (Medigap) is in place.
  • Medigap Plans are standardized by the federal government.
  • Medigap Plans are designed to cover some or all of the cost-sharing under Original Medicare.

Pros of Medicare Advantage Plans:

  • Parts A, B and usually D are combined.
  • Some plans have $0 premiums.
  • Pay for services as they occur.
  • Many include additional benefits such as gym member­ships, dental, vision and hearing.

Here are the changes you can make during the annual open enrollment period:

  • Change from Original Medicare to a Medicare Advantage Plan.
  • Change from a Medicare Advantage Plan back to Original Medicare.
  • Switch from one Medicare Advantage Plan to another Medicare Advantage Plan.
  • Switch from a Medicare Advantage Plan that doesn’t offer drug coverage to a Medicare Advantage Plan that offers drug coverage.
  • Switch from a Medicare Advantage Plan that offers drug coverage to a Medicare Advantage Plan that doesn’t offer drug coverage.
  • Join a Medicare Prescription Drug Plan.
  • Switch from one Medicare drug plan to another Medicare drug plan.
  • Drop your Medicare prescription drug coverage completely.

Whether you are new to Medicare or want to make changes, carefully read the details of each plan before you make a decision. For more infor­mation, call 1–800-MEDICARE or go to Medicare​.gov.