Choosing Between Original Medicare and Medicare Advantage

When enrolling in Medicare insurance it is important to do it on time. The enrollment period is individually based. Open-enrollment occurs three months prior and three months after an individual’s 65 birthday. If you miss the enrollment deadline you could end up paying higher premiums.

The first decision to make when enrolling in Medicare whether to choose Original Medicare or Medicare Advantage. Original Medicare, which is Part A and Part B, covers hospital expenses, some non-hospital costs including supplies, outpatient care and certain kinds of medical appointments. Medicare plans are offered by the federal government and permit beneficiaries to use any health care professional that accepts Medicare.

On the other hand, Medical Advantage offers beneficiaries a variety of health insurance plans from private insurance companies, which are typically PPOs, HMOs and EPOs. Most of these offerings charge a monthly premium in addition to the basic Part B premium. These plans may also a greater range of coverage choices.

There is no right or wrong when choosing the plan that best suits you and your circumstances. However, it is important that you make the right choice that suits you when you enroll, otherwise you stand to lose access to some options once open enrollment ceases. During open enrollment for Medicare Advantage, plans offered are not allowed to decline health insurance coverage. If you miss open enrollment health insurance providers could decline to issue health insurance to you.

For those choosing to go with Original Medicare, they might want to consider basic coverage with a Medigap plan. These plans are sold by private insurance companies and offer coverage for health care expenditures that do not fall under Part A or Part B. Once the decision is made to purchase a Medigap plan, you need to consider which type to get. There are 10 different standardized options (the same coverage is available no matter where you live or who is selling it).

The vast majority of beneficiaries new to Medicare choose Medicare Part D, which offers prescription drug coverage. However, this is optional, depending on what other Medicare plans you have selected. Original Medicare and Medigap do not offer prescription drug coverage, so it is recommended to choose Part D.

There are some Medicare Advantage plans offering drug coverage as a component of the basic plan but you need to ask about it during enrollment. If your Medicare Advantage plan does have good drug coverage, then you could skip Part D.

In general, always ask questions when making health care insurance choices because if you do not you may find that you are not covered for a certain procedure.