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You’re eligible for Medicare. What plans do you choose? How do you know what coverage you need? Here is a quick guide to get you started.

Original Medicare vs. Medicare Advantage

Original Medicare is offered by the federal government and provides hospital and general medical expense coverage. Medicare Advantage is offered by private insurers and is an “all-in-one” alternative to Original Medicare that covers more services and costs.

Which is right for you? These are key differences between each plan to help you better compare options:

  • Most Medicare Advantage programs offer full prescription drug coverage, while Original Medicare only includes limited prescription drug coverage in certain situations. If prescription drug coverage is a priority for you, Medicare Advantage may be your best option.
  • Both plans allow you to choose any doctor who accepts your Medicare coverage. Some Medicare Advantage plans, however, have a specific network for you to seek coverage in, which lowers the overall cost of the plan. Medicare Advantage has multiple plans to choose from if you do not want to be limited to a network.
  • Medicare Advantage provides additional coverage such as dental, vision, and hearing care that Original Medicare alone does not.
  • Both Medicare Advantage and Original Medicare have deductibles and copayment/coinsurance fees. Both plans also require you to pay your Part A and B deductible (unless you are eligible for Premium-Free Part A). 
  • Under Medicare Advantage, you will have an annual maximum out-of-pocket spending limit. This means that you will only be required to cover a limited amount of out-of-pocket costs—once you have paid to a certain point, your plan will pay for the rest. Original Medicare does not have this feature.

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Medicare Advantage Plan Comparison

There are 4 main types of Medicare Advantage plans, including Private-Fee-For-Service (PFFS), Preferred Provider Organization (PPO), and Health Maintenance Organization (HMO) plans. We have discussed these plans in-depth, so let’s now compare them.

PFFS plans offer the greatest overall healthcare provider options, in or out-of-network. Most plans include prescription drug coverage—if it does not, you have the option to add Medicare Part D to your plan, unlike HMO and PPO. If you prefer to have a wide range of coverage options, this plan may be a great fit for you.

HMO plans have the smallest overall cost of the three. With this low cost, you will only be paying for the coverage you need as you need it. You must, however, stay within this network. If you prefer having the consistency of a primary care doctor that refers you to the specialists and prescriptions you need, an HMO plan may be best for you. 

If you prefer having access to out-of-network doctors, then a PPO may be better suited for you. This plan will work well for you if you travel and want less expensive care more regularly. 

Medicare Supplement Plan Comparison

Medicare supplements are available to provide additional cost coverage to you Original Medicare. If you prefer this to the additional coverage offered by Medicare Advantage, you may want to investigate your supplement options further.

If you would like to see a full comparison of all 12 Medicare Supplement plans, check out our comparison chart here.

Want an Expert to Help You Compare Plans?

Our goal is to match you with the best possible coverage for your healthcare needs and budget. As MedicareMisty’s founder quotes, “It is not about what makes me the next dollar. I have walked away from a sale or given a sale away and it always works out. If you do the right thing, it will always come back to you.”

If you need help comparing Medicare plans, talk with one of our experts and give us a call for a free quote and consultation.