Medicare Advantage versus Original Medicare
Not a question of which is better, but of where you would rather carry the risk: in a monthly premium, or in the year you get sick.
By Meg Quillen, Cedar Landing Benefits
The honest version of this comparison has no winner. Both routes are legitimate, both are chosen by sensible people, and the right answer changes with your doctors, your county and your tolerance for administration.
What follows is the way we lay it out at the kitchen table.
Original Medicare plus a Supplement
You pay a monthly Supplement premium on top of Part B, and in exchange most of what Medicare leaves behind is covered. Any provider in the country who accepts Medicare will see you, there are no networks, and specialists do not need referrals.
The trade is cost certainty in the other direction: you pay the premium every month whether you see a doctor or not, and it generally rises with age. You also need a separate Part D plan for prescriptions.
Medicare Advantage
An Advantage plan replaces the way you receive Medicare. Premiums are often very low, drug cover is usually included, and extras such as dental allowances and gym memberships are common. In exchange you use a network, you may need referrals, and you pay copays as you go up to an annual maximum.
For a healthy year the maths is comfortable. For a year with a hospital admission and a course of specialist care, you may reach that annual maximum — which is exactly what it exists for, but it is money you will feel.
The question that usually settles it
Ask yourself what a bad year would look like. If having to check whether a specialist is in network during a difficult month would distress you, the Supplement route is worth its premium. If you would rather keep the monthly cost low and accept copays when they arrive, Advantage does that well.
One warning worth stating plainly: moving from Advantage back to a Supplement later can require medical underwriting outside a guaranteed-issue window. The first choice is freer than the second.
An estimate for planning, not a quote. Medicare and the Marketplace set your real figures.
Have a question this raised?
General writing only goes so far. Your doctors, your medication list and your dates decide what the right answer is for you.
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