Original Medicare, Medicare Advantage, and the maze of alphabet options can be hard for anyone to understand. It is difficult to get a clear comparison of what benefits each has to offer with the costs associated. Let’s focus on choosing between Original Medicare and Medicare Advantage based on six areas: premiums, prescription costs, extra benefits, overall plan costs, co-pays and access to doctors and hospitals.
Your premium is how much you pay in order for the plan to cover you – this does not include how much you will pay for your care or prescriptions.
Most people don’t pay a Part A premium because they paid Medicare taxes while working. If you don’t get premium-free Part A, you pay up to $437 each month
The standard Part B premium amount in 2019 is $135.50 or higher depending on your income.
Since these plans come from private insurance companies, the cost can vary from company to company. In most states, there are plans that cover drugs at no additional cost, but it requires you to pay the Part B premiums.
2. Drug Costs
The drug cost entails how much you can expect to pay for your actual prescription when you go to the pharmacy.
Separate but Equal: Both original Medicare and Medicare Advantage are similar in the out-of-pocket costs associated with prescription drugs. With Original Medicare, you can add Medicare Part D prescription drug coverage to your plan and many Medicare Advantage plans come with drug coverage. The 2019 Part D National Base Beneficiary Premium is $33.19
After any necessary deductible, you are responsible only for a co-pay, which varies from plan to plan.
3. Extra Drug Benefits
There are a variety of extra benefits available in each plan that are worth asking about with your specific representative.
Other types of extra drug benefits might be plans who cover some of the costs of generic or brand name drugs in the coverage gap or a plan might cover “excluded” drugs that Medicare drug coverage normally would not pay for.
For example, some plans might offer a coverage gap, which means you will pay a percentage of the costs of your drugs. In 2019, enrollees pay 25% for name brand drugs and 37% for generic drugs.
4. Overall Plan Costs
In addition to the cost of drugs, you should also think about how much the plan you choose will cost overall.
Typically has no premium for Part A, but Part B does have a minimal premium cost, as mentioned in the first section.
Plans often include a premium for health care coverage, on top of your Part B premium. To figure out your overall costs, you need to include premiums, deductibles, and copays included in your plan.
Copayments are what you will be required to pay for medical services at a doctor’s office or hospital.
For doctor visits and other medical services, you pay 20% of the approved charge after you meet your annual deductible.
Medicare Advantage plans have lower co-pays for visits to doctors in their network. However, there is a higher co-pay for doctors outside of the network.
6. Access to Doctors and Hospitals
Your access to doctors and hospital may vary from plan to plan. It is important to understand how much choice you have about which doctors and hospitals you use.
You have the ability to choose your doctors and hospitals.
You choose your doctors from a network of available options. If you use a doctor who is not in your network, you may have to pay more out of your pocket.
Know Your Options Before You Make A Decision
Deciding between Original Medicare and Medicare Advantage can be a stressful decision. With so many options and prices, it’s important to know exactly what you need.
Talking with an independent agent at Braden Insurance can get you on the right track. With our free, unbiased consultations, you will help you make the best decision for you and your pocketbook.