Original Medicare vs. Medicare Advantage Plans

According to the experts, Original Medicare is considered to be a safety net. However, it is found not to pay 100% charges that are incurred for all covered services. Besides this, coverage for other types of services like routine dental, vision and hearing is not provided by Medicare. Hence, cost sharing offered by Original Medicare includes co-insurance, co-pays and hospital deductibles for outpatient services. It is stated by majority of Medicare beneficiaries that they will not be able to pay the remaining 20% not covered by Medicare. It is the outpatient co-insurance that they are referring to.

What is offered by Part C Medicare?

  • Drug coverage Part D included with Plan C, resulting in cost savings.
  • Co-pays for covered services like testing, emergency room visits and doctor’s visits.
  • Medicare Advantage Plans does include Medicare rejected additional services coverage like vision, dental, hearing and health club memberships.
  • People having special needs can find Advantage plans to be more focused upon individual needs.
  • Medicare Advantage Plans also offer beneficiaries with maximum out of pocket annual coverage. The cost sharing amount with Medicare does not get capped annually. But with Advantage plan, if the person reaches specific threshold, then costs for covered services will be borne 100%.

Supplement insurance policies are being offered for more than four decades. Premium is received by the insurance provider against filling up the gaps left by Original Medicare.

Reasons for supplement not being feasible

Not every individual will be able to qualify for Medicare Supplement. Hence, Medicare Advantage Plans 2019 can be the right solution. Supplement is not found feasible for the following reasons:

  • Expensive premiums
  • Beneficiary being dual eligible, which is to qualify for both Medicaid and Medicare, hence, not qualifying for supplement.
  • Guarantee enrollment period missed out by beneficiary for supplement and medically not qualifying because of policy underwriting requirements.

Employer group insurance vs. Medicare Advantage Plans

There are many who are eligible for Medicare and can maintain coverage, while being employed or through former employer. It is a benefit for having insurance against years of service with the organization. Those who are coverage eligible are likely to opt out to select Part C.  The reasons are as follows:

  • Expensive premiums for employer plan
  • Co-insurance, co-pays and deductibles costly than Advantage plans
  • Employer plan not covering comprehensive like Advantage plan
  • Employer plan restrictive in network as well as not meeting requirements of retiree requiring more flexibility.
  • Beneficiary uncertain about duration of the availability of plan benefit because of employer volatility and eager to get some certainty.

The choice to select a plan is entirely that of the individual, which needs to be wise and smart.