Medicare or Medicare Advantage Plan: What’s the Difference?

Submitted by:
Laura Mutsko
Certified Senior Adviser and Agent
Mutsko Insurance Services, LLC

Q.   I’ve been satisfied up to now with my Original Medicare insurance.  Don’t Medicare and all the private Medicare Advantage Plans provide about the same coverage?  Why should I change to a Medicare Advantage Plan?

A.   Just like everything else, your health care coverage needs can change over the years. That is why you should consider these facts before you decide that a Medicare Advantage plan is not the right choice for you.

1. Original Medicare and Medicare Advantage plans are not the same. Advantage plans are offered by insurers who are contracted by the government to provide you with all the benefits in Medicare’s Part A (hospital insurance) and Part B (medical insurance) coverage. Those enrolled in a Medicare Advantage plan will still be in the Medicare Program and have Medicare rights and protections.
2.  Many Advantage plans offer benefits that go well beyond those in Original Medicare. Advantage plans may include prescription drug coverage, routine vision and dental coverage, and health club memberships, among others. This year, some plans are enhancing their coverage for hearing aids and podiatry services. 
3. Unlike Original Medicare, Advantage plans have a yearly limit on your out-of-pocket costs for medical services. The limit for 2016 was no more than $6700 with some plans   capping costs at a lower amount. Once you reach this limit, you’ll pay nothing for covered services. There is no out-of-pocket limit with Original Medicare.
4. Monthly premiums for a Medicare Advantage plan will depend on the plan you select, with some plans available for zero monthly premiums.
5. Each plan is permitted to make annual changes in their costs, coverage and benefit package. That’s why it is always a good idea to review your coverage to avoid getting locked into a plan that may no longer work for you. Here are some key points to consider:

• Have there been any changes in your health that affect the services you may need or how often you may need them?
• Are your doctors, hospitals and specialists in the plan’s provider network?
• Will the drugs you currently take be covered? What tier will they be in, and at what cost?
• Will your co-pays, co-insurance or deductibles be affordable for you?

Whether you decide to stay with Original Medicare or look at other options, you want to make your decision based on facts. The time to make any changes is during Medicare’s Open Enrollment which is going on now and will end on December 7.

If you would like help finding the right Medicare Advantage plan for you, call me to set up a Medicare health insurance review. My office is conveniently located at 6966 Spinach Drive in Mentor, just around the corner from Route 2 and 615. I can be reached at 440-255-5700 or Lmutsko@mutskoinsurance.com.