Original Medicare vs.
Medicare Advantage
Your Choice Matters
Your Choice Matters
A significant decision facing seniors every year is selecting the best Medicare plan for their individual health needs. While many choices exist, it is important to remember that not all Medicare plans are the same and some may even restrict seniors from seeing preferred healthcare providers or accessing certain treatments.
At St. Elizabeth, we believe our patients deserve access to the trusted healthcare providers they choose. And they shouldn’t be subjected to potentially harmful administrative burdens and possible delayed or denied care.
The most important thing seniors can do is to become educated about the different types of Medicare plans and how those plans will best meet their needs.
That is why we are taking a proactive approach to educating our patients, our associates, and the community about the important choices available when selecting a health plan during the annual open enrollment period each fall.
What is the Difference Between Original Medicare and Medicare Advantage?
Original Medicare is the national health program for seniors administered by the federal government. It covers everyone eligible, anywhere in the country, and provides in-network access to nearly all healthcare providers. Some consider it “real” Medicare because of how it differs from private, for-profit Medicare Advantage plans administered by private insurers.
Medicare Advantage plans do not provide in-network access to all providers, and they may not fully cover many important health services. These plans may also often require more complicated approvals before needed care is provided.
Important Things to Consider When Choosing Your Medicare Plan
During the open enrollment period each autumn, you can expect to see a surge in advertisements from insurance companies promoting various Medicare Advantage plans. You should do your own research and not base your decisions solely on advertising, because choosing the wrong plan can have significant consequences, whether you’re enrolling in Medicare for the first time at age 65 or reevaluating your coverage options at age 85.
Your First Decision Matters
Opting for a Medicare Advantage plan at the age of 65, while you’re likely in good health, may not serve you as well later as your health status changes or if medical issues arise. It is important to consider future long-term care requirements and their associated expenses. As you grow older, your health care needs could evolve significantly, and by choosing a Medicare Advantage plan at 65, it might restrict your choices in the future.
Don’t Forget about Medigap Coverage
At age 65, you are guaranteed to be eligible for a Medigap plan to complement your Original Medicare coverage. If you opt into a Medicare Advantage plan at age 65 and want to switch to original Medicare when you are older, you may no longer qualify for a Medigap plan, or it may be much more expensive.
Think Long-Term About Your Health Needs
Hopefully, you are healthy now, requiring very little medical care. But if that changes over time, some patients with significant medical issues have reported experiencing delays in care due to prior authorizations or denials required by Medicare Advantage plans. Once you choose a Medicare Advantage plan, moving to original Medicare can be challenging and more expensive.
Do You Travel Often or Spend Part of the Year in Another State?
If you travel/live part of the year in another state and are enrolled in a Medicare Advantage plan, you may be out of network, which increases the cost of your care (except for emergency care). Original Medicare includes nearly every provider, providing you more options for care across the country.
Exercise Caution Against Fraud
In exploring Medicare plans, you are advised to be vigilant about fake Medicare websites, salespeople posing as reputable advisors, and scammers. If unsure, always refer to websites ending in (.gov) for reliable Medicare information.
Educational Resources
While it may seem overwhelming, there are many choices when it comes to your Medicare coverage. We are here to help you consider your Medicare options and choose a plan that best suits your needs during open enrollment in October.
Our St. Elizabeth physicians and staff stand ready to discuss your options, explain plan differences, and help you make an informed decision that meets your needs. When evaluating different plan options, we encourage you to take advantage of unbiased resources, including:
Help is Available
Seniors can also access counselors through the State Health Insurance Program (SHIP) who can answer questions and advise on Medicare plans.
To contact SHIP counselors:
- Kentucky residents should call 1 (866) 516-3051.
- Indiana residents should call 1 (800) 452-4800.
If you need to find a SHIP counselor in another state, visit this national directory of counselors at https://www.shiphelp.org/ – select your state to find a SHIP counselor near you.
RetireMed® is a company with offices in the Cincinnati area that helps older adults find the right plan for their unique needs, budget and lifestyle. RetireMed® works with most major insurance companies to ensure you have access to a wide range of reliable coverage options. They offer lifelong support – all at no cost or obligation. Contact RetireMed® at 1 (866) 591-3911 or visit the RetireMed® website for more information.
Experts from Chapter can provide advice on choosing a plan as well, with the following services available:
Learn more at https://askchapter.org/ or call (855) 900-2427
