How to decide between Medicare and Medicare Advantage?

By ​​Jim Pittman Director of Medicare Advantage Communications - Ochsner Health Plan and Liz Miller Communication Manager GetSetUp 

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Deciding between Medicare and Medicare Advantage does not have a one size fits all kind of answer. There are a lot of factors that go into these decisions. For more extensive research customized to your needs, we suggest you go to Medicare.gov where you can read about each plan in-depth and compare the benefits of plans specific to your area. All you have to do is put in your zip code and then find the plans that are available where you live and you can compare the benefits side by side. 

Jim Pittman the Director of Medicare Advantage Communications - Ochsner Health Plan has worked in health and managed care for over 30 years and says that medicare choices are unique to each individual. 

“Sometimes plans might offer richer benefits in one local area and not be available in other regions. While the total cost for care might still be $0, you want to make sure you get a plan that offers a network of providers that you are confident can handle your care and covers your prescription medications and all of your health and wellness needs.” said Jim. 

All Medicare plans include 

Regardless of what plan you get if you are enrolled in Medicare then you are entitled to some basic benefits: 

• Medical services to diagnose and treat diseases, illnesses, and injuries
• Necessary medical equipment or devices indicated by a doctor such as wheelchairs, walkers, oxygen, and prosthetic devices. 
• Preventative care includes routine physical exams, screening tests, and most vaccines and immunizations

*Medicare does not cover prescription drugs, routine, vision, dental, or hearing care or pay for long-term care. 

You can add Medicare Part D which is a private insurance plan that covers prescription drugs to original Medicare. It may include an annual monthly fee (which is estimated to be $33 a month for 2022). 

“You can’t beat the price and rich benefits offered by Medicare Advantage plans. They are typically offered at zero monthly premium and very little out-of-pocket cost for the member. Most Medicare Advantage programs cover prescription drugs, hearing vision, dental, and often offer fitness options in addition to the traditional health benefits provided by Medicare Parts A or B.,” said Jim. 

Original Medicare vs. Medicare Advantage at a glance

To help you compare original Medicare with Medicare Advantage plans we have put together a chart of some of the key feature differences between the two plans.

Which is better original Medicare or Medicare Advantage?

There is no solid answer to this question. The best medicare plan is a personal decision based on each individual’s needs and the options that might be available to them. Sometimes the best plan for you might not meet the needs of your spouse, friends, or family. That’s why it is important to research, compare benefit options, cost and network’ and consider key factors such as : 

• Your work history and thus qualifications for Medicare benefits 
• Your tax deductibles that can be applied to Medicare 
• Your health 
• Your living and traveling requirements (will you stay in one place)
• The healthcare providers in each plan’s network
• If you want your health care to focus on problems and/or prevention
  

Regardless there is good news you can change your plan annually during enrollment from Oct. 15- Dec. 7 so if your life circumstances change, you move, or you have better options available there is time to update!