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Traditional Medicare has parts A (hospital), B (outpatient) and D (pharmacy benefits). Medicare Advantage, which is run through a managed care ordganization and referred to as Part C, combines the benefits of parts A, B, D and sometimes additiaonl benefits (like vision and dental) that are not typically covered by Traditional Medicare. Medicare part A is free, but the premiums for Traditional Medicare part B can run as high as $250/month and you have to pay 20% of the costs of outpatient services like Doctors visits. Seniors enrolled in traditional Medicare ofter will purchase a "supplemental insurance plan" to help cover the additional 20% of non-paid services.
On the other hand, The National Council on Aging reports that Monthly premiums for Medicare Advantage plans for 2024 average $18.50/month. And since Medicare Advantage typically offers an expanded benefits plan (list of covered medical services) the choice between the two plans seems to be a simple choice: Why pay 10x more for a Traditioanl Medicare plan when you can get more services through the much cheaper Medicare Advantage plan? Well there are two major differences between the two plans that might have you second guessing the Medicare Advantage plans. Perhaps the biggest disadvantage of Part C plans is that your provider network, Doctors and hospitals that you are allowed to to visit, is ALWAYS more restrictive than traditional Medicare Parts A & B. If you happen to see a doctor or provider who is not in the Advantage network, you can be paying a sizable part of your billed services for going to see an out-of-network provider. In addition, Medicare Advantage can sometimes issue a denial of coverage for medically necessary care or care they feel is not necessary, and this can also be done retroactively thereby denying coverage for care you thought was being covered by your plan. However, if this ever happens to you there is still hope of getting coverage by appealing the denial for services:
If a Medicare Advantage plan denies you coverage for services don't take it lying down. File an appeal, and your odds are good that the plan will overturn its decision. That's the message for consumers in a government report examing service and payment denials in Medicae Advantage plans. For help filing an appeal contact: Medicare Rights Center, and advocacy group for Medicare beneficiaries, to medicarerights.org or call 800-333-411
So which plan is best for you? That depends. In 2024 seniors were evenly split between plans with 50% enrolling in traditional Medicare and 50% choosing an Advantage plan. You should probably look at your health status and if you've experienced extended hospital stays or specialists services traditioanl Medicare might work best for you. Your financial situation obviously will play a big part in your decision as will the size of the networks for your Advantage plans or how many Medicare Advantage plans you have to choose from. City dwellers usually have a greater number of Medicare Advantage plans to select from vs. rural Americans and the competition may result in more competitive premiums.
And finally, fear not, even if you are enrolled in a plan you do not like, every Medicare benefitiary has the option to switch to another Advantage plan or even back to Traditional Medicare plan during the annual open enrollment period which runs from October 15 through December 7th.
On the other hand, The National Council on Aging reports that Monthly premiums for Medicare Advantage plans for 2024 average $18.50/month. And since Medicare Advantage typically offers an expanded benefits plan (list of covered medical services) the choice between the two plans seems to be a simple choice: Why pay 10x more for a Traditioanl Medicare plan when you can get more services through the much cheaper Medicare Advantage plan? Well there are two major differences between the two plans that might have you second guessing the Medicare Advantage plans. Perhaps the biggest disadvantage of Part C plans is that your provider network, Doctors and hospitals that you are allowed to to visit, is ALWAYS more restrictive than traditional Medicare Parts A & B. If you happen to see a doctor or provider who is not in the Advantage network, you can be paying a sizable part of your billed services for going to see an out-of-network provider. In addition, Medicare Advantage can sometimes issue a denial of coverage for medically necessary care or care they feel is not necessary, and this can also be done retroactively thereby denying coverage for care you thought was being covered by your plan. However, if this ever happens to you there is still hope of getting coverage by appealing the denial for services:
If a Medicare Advantage plan denies you coverage for services don't take it lying down. File an appeal, and your odds are good that the plan will overturn its decision. That's the message for consumers in a government report examing service and payment denials in Medicae Advantage plans. For help filing an appeal contact: Medicare Rights Center, and advocacy group for Medicare beneficiaries, to medicarerights.org or call 800-333-411
So which plan is best for you? That depends. In 2024 seniors were evenly split between plans with 50% enrolling in traditional Medicare and 50% choosing an Advantage plan. You should probably look at your health status and if you've experienced extended hospital stays or specialists services traditioanl Medicare might work best for you. Your financial situation obviously will play a big part in your decision as will the size of the networks for your Advantage plans or how many Medicare Advantage plans you have to choose from. City dwellers usually have a greater number of Medicare Advantage plans to select from vs. rural Americans and the competition may result in more competitive premiums.
And finally, fear not, even if you are enrolled in a plan you do not like, every Medicare benefitiary has the option to switch to another Advantage plan or even back to Traditional Medicare plan during the annual open enrollment period which runs from October 15 through December 7th.
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