Choosing between Medicare Advantage and Original Medicare is a critical decision, especially during the Annual Enrollment Period (AEP), which runs from October 15 to December 7 each year. This period is your opportunity to review and change your Medicare coverage, and the choice you make can have a significant impact on your healthcare and financial well-being. Understanding the pros and cons of each option is essential to making an informed decision that best suits your needs.

What is Original Medicare?

Original Medicare, often referred to as traditional Medicare, includes Part A (hospital insurance) and Part B (medical insurance). It covers most medically necessary services and supplies in hospitals, doctors' offices, and other healthcare facilities.

Pros of Original Medicare:

  • Freedom of Choice: You can see any doctor or specialist who accepts Medicare, in most cases without needing a referral.
  • No Network Restrictions: You aren’t limited to a network, making it easier to receive care from healthcare providers nationwide.
  • Predictability: The costs are predictable with set premiums, deductibles, and coinsurance rates. 

Cons of Original Medicare:

  • No Out-of-Pocket Maximum: Original Medicare has no yearly limit on what you pay out-of-pocket, unless you have supplemental coverage like Medigap.
  • Limited Coverage: Original Medicare doesn’t cover everything. For example, it doesn’t include prescription drugs (Part D), vision, dental, or hearing services. You may need to purchase additional coverage, like a Medigap policy, to fill in the gaps.

What is Medicare Advantage?

Medicare Advantage, also known as Part C, is an alternative to Original Medicare. It’s offered by private insurance companies approved by Medicare. These plans must provide at least the same level of coverage as Original Medicare, but they often include additional benefits like prescription drug coverage, dental, vision, and hearing care.

Pros of Medicare Advantage:

  • All-in-One Coverage: Medicare Advantage plans often bundle medical, hospital, and prescription drug coverage into one plan.
  • Extra Benefits: Many plans offer additional services, such as dental, vision, hearing, and wellness programs.
  • Out-of-Pocket Maximum: Medicare Advantage plans have an annual out-of-pocket maximum, providing a financial safety.

Cons of Medicare Advantage:

  • Network Restrictions: Most Medicare Advantage plans have a network of doctors and hospitals you must use for non-emergency care.
  • Referrals and Pre-Authorizations: You might need a referral to see a specialist, and certain services may require pre-authorization.
  • Plan Changes: Medicare Advantage plans can change their benefits, provider networks, and costs from year to year, which can make it challenging to keep track of your coverage.

Compare Original Medicare vs. Medicare Advantage.

What to Consider During AEP

When choosing between Medicare Advantage and Original Medicare during AEP, keep these important factors in mind:

Your Health Needs

Think about your current health and any upcoming medical care you might need. Make a list of your doctors, specialists, and medications. Check if they're covered by the plans you're considering.

Costs

  • Look at the big picture of expenses
  • Monthly premiums
  • Yearly deductibles
  • Co-pays for doctor visits and prescriptions
  • Out-of-pocket maximums

Remember, Original Medicare has no out-of-pocket maximum, while Medicare Advantage plans do.

Coverage

Consider what each plan covers:

  • Does it include prescription drugs?
  • Are dental, vision, and hearing services included?
  • Are there any extra benefits like gym memberships or transportation?

Choice of Doctors

Think about how important it is for you to choose your own doctors:

  • Original Medicare lets you see any doctor who accepts Medicare
  • Medicare Advantage plans often have a network of doctors

Travel Plans

If you travel often, especially outside the U.S.:

  • Original Medicare generally doesn't cover care outside the country
  • Some Medicare Advantage plans offer limited foreign travel coverage

Making the Right Choice

Choosing between Medicare Advantage and Original Medicare is a personal decision that depends on your health, finances, and preferences. During AEP, take the time to review your options carefully. Remember, this is your opportunity to adjust your healthcare coverage to better meet your needs for the coming year.

If you're still unsure which option is best for you, consider joining a Medicare class on GetSetUp. Our Guides can help help you through the process and answer questions you have. Take control of your healthcare decisions this AEP—join us today!

Reviewed By: Keith Gilbert