What Is Better, Traditional Medicare, or Medicare Advantage?

What Is Better, Traditional Medicare, or Medicare Advantage?

Traditional Medicare and Medicare Advantage are two insurance options for people ages 65 and older living in the United States. Traditional Medicare and Medicare Advantage are not the same, and depending on your situation, there are advantages and disadvantages for each.

Your medical needs, budget, and other personal lifestyle factors can all play a role in which type of Medicare coverage is better for you. In this article, we’ll explore the differences between Traditional Medicare and Medicare Advantage, and how to decide which one is better for your medical needs.

What is Medicare?

Traditional Medicare, also known as Original Medicare, is a government-funded medical insurance option for people ages 65 and older. Many older Americans use Medicare as their primary insurance option, since it covers:

• Hospital-related services (Part A). These benefits include coverage for hospital visits, nursing facility care, at-home health care, and hospice care.
• Medical services (Part B). These benefits include coverage for preventive, diagnostic, and treatment services for health conditions.

Medicare generally doesn’t cover prescription drugs, dental, vision or hearing services, or additional healthcare needs.

However, for people who have enrolled in Original Medicare, there are add-ons such as Medicare Part D and Medigap that can offer additional coverage.

What is Medicare Advantage?

Medicare Advantage, also called Medicare Part C, is an insurance option for people who are already enrolled in Medicare Part A and Part B.

Advantage plans are offered through private insurance companies, and many plans cover hospital, medical insurance, and additional services such as:

• prescription drugs
• dental services
• vision services
• hearing services
• fitness services, plus other health perks

Medicare Advantage takes the place of traditional Medicare add-ons, such as Part D and Medigap. Instead of having multiple insurance plans to cover medical costs, a blue cross medicare advantage offers all your coverage in one place.

How to determine which meets your needs

Original Medicare and Medicare Advantage differ in their coverage, costs, and benefits. When comparing your options, there’s no “one plan fits all.”

Medical services

If you’re someone who rarely visits the doctor, Medicare and Medicare add-ons may cover most of your needs.

However, if you’re someone who wants coverage for yearly dental, vision, or hearing exams, many Medicare Advantage plans offer this type of coverage.

Health conditions

If you have a chronic health condition, such as cancer, chronic heart failure, stroke, dementia, or other condition, it’ll affect your medical coverage.

For example, Medicare may not cover all your needs, but a Medicare Advantage Special Needs Plan (SNP) could help with long-term costs.

These plans are designed for people with one of several chronic health conditions. They offer:

• coverage for specialists and case managers
• access to medications specifically for your condition
• access to other benefits

Research has shown that Medicare Advantage plans can help consumers save more money on certain medical necessities, such as laboratory tests and medical equipment.

Medications

Original Medicare generally doesn’t cover prescription drug costs. In order to receive coverage for prescription drugs, you need a Medicare Part D plan or Medicare Advantage plan with prescription drug coverage.

No matter what option you choose, you’re required to have some form of prescription drug coverage within 63 days of enrolling in Medicare, or you’ll be required to pay a permanent penalty.

Budget

If you have Medicare, you’ll pay a monthly premium for Part A (if you don’t qualify for premium-free Part A) and Part B, a yearly deductible for Part B, and other costs if you have add-ons.

If you have Medicare Advantage, you may need to pay additional costs depending on the plan. Before choosing the type of plan you want, consider what out-of-pocket costs you can afford each year.

Provider preference

While Medicare offers the freedom to choose any provider within the Medicare network, most Medicare Advantage plans don’t provide as much freedom.

Depending on the type of Advantage plan you have, you may face additional costs for out-of-network services, as well as specialist referrals and visits.

Travel frequency

For some people, travel is a way of life. This is especially true for people who retire and choose to travel or who live some place warmer during the colder months.

If you travel frequently, consider what out-of-state medical needs you may have. In most cases, Medicare coverage is nationwide, while Medicare Advantage plans require you to stay in your local area for medical services.