As you consider how Medicare can help cover your health care needs, your first decision should be which type of insurance to enroll in: the federally funded Original Medicare plan. or a private Medicare Advantage plan. Some aspects of your care will be the same regardless of your chosen plan, but others will be significantly different. Here’s what you should know. 

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Table of Contents:

Choosing Between Medicare and Medicare Advantage

Moorestown financial advisor explaining Medicare and Medicare AdvantageIf you elect to go with what’s referred to as Original Medicare, you’ll get: 

  • Part A (hospital insurance)
  • Part B (doctor visits/outpatient care insurance)
  • Part D (prescription drugs coverage) 

If you choose Part C, a Medicare Advantage plan, this will be bundled with Original Medicare Parts A and B. 

Let’s take a closer look into these two options and which is best for your needs. 

Going to the Doctor Under Medicare vs. Medicare Advantage

Under Original Medicare, you can choose any providers that accept Medicare. Thankfully, 93 percent of non-pediatric primary care doctors accept Medicare. However, 30 percent of primary care doctors aren’t accepting new Medicare patients, so check on this before switching doctors. 

With Medicare Advantage, things are slightly different depending on whether you have an HMO or PPO. If you use an HMO plan, be aware that you’ll be limited to a specific network of hospitals and doctors. 

Covered Care 

Medicare covers most medical needs except vision, dental, and hearing. Fortunately, you can pick up a supplemental plan to cover these services. Under Medicare Advantage, you get all the same services as you do with Original Medicare and some coverage for dental, vision, and hearing. 

While Medicare Advantage plans do look attractive, there are some pitfalls. For example:

  • You must follow specific plan rules to get coverage
  • You’re limited on the doctors you can see
  • You may have trouble getting emergency care due to rationing 

And unfortunately, some private plans aren’t financially stable and may suddenly stop providing coverage. 

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What Are the Costs of Medicare and Medicare Advantage

With Original Medicare, the federal government sets the premiums, deductibles, and coinsurance for Part A and Part B. For example, you’re responsible for 20 percent of a doctor's visit or lab bill. Many choose to take out a supplemental plan to help pay these costs. 

Medicare Advantage plans work a little differently. You’ll still have to pay the government-set premiums, but instead of paying 20 percent coinsurance, your plan will probably have a set copay amount. This can lead to lower out-of-pocket costs, although not always. 

Be aware that some hospitalizations, outpatient services, and medical equipment often cost more under Medicare Advantage plans. 

What Our Moorestown Financial Advisor Recommends

While there are some great features to Medicare Advantage plans, we generally don’t recommend them. You’re far more limited in choice, your out-of-pocket costs can quickly add up, and you must follow specific rules to get covered care. 

Your best option is Original Medicare and a supplemental plan that fills the gaps and helps cover out-of-pocket costs. 

Still Need Help Navigating Medicare Options?

The system can be overwhelming, but the licensed Medicare insurance agents at Leonard Financial Solutions can help. From navigating the enrollment process to assessing the right plans for your needs, we provide thorough information and guidance so you can make truly informed decisions about your financial future.

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When you work with us, you can rest assured the options you choose align perfectly with your overall goals for financial security. Contact us today for a free consultation by clicking the button above or calling 856-444-5433 now. Although we're located in Moorestown, New Jersey, we serve clients from all over the United States.

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