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Which is better, Original Medicare or Medicare Advantage?

By on August 9th, 2012
Filed: Advice, Caregivers, Consumers, Disabled, Early Retirees, Families, FAQs, Parents, Seniors, Tips

This is a trick question, because any answer should be based on your own personal needs. Here are some questions you should ask when trying to determine on your own whether or not to stick with basic Medicare, or to pick the right Medicare Advantage plan for yourself:

1. Do I want to buy drug coverage separately? “Original Medicare,” (Parts A & B) does not cover the cost of prescription drugs. Most Medicare Advantage plans include prescription drug coverage. If you go with original Medicare, you’ll need to enroll in a stand-alone Medicare Part D prescription drug plan separately.

2. Does the plan cover the prescription drugs you’re taking at the lowest possible cost? Your actual drug plan costs will vary depending on the following criteria, and possibly others as well:

  • What prescriptions you use;                       
  • Does the plan cover those drugs;                      
  • Which plan you choose; 
  • Which pharmacy you use;
  • Whether or not you get “Extra Help” (a low-income subsidy) paying your Part D costs.

Trying to figure it all out on your own is hard. That is why we created the PlanPrescriber.com prescription drug plan comparison tool. It’s designed to help people determine which Medicare Advantage or Part D prescription drug plan covers their drugs at the lowest possible cost.

3. Do your doctors accept the plan? Not all doctors accept Medicare, and the same is true for Medicare Advantage. Most Medicare Advantage plans are either HMOs or PPOs, which means they’ll have a list of preferred doctors and hospitals that you’ll need to use in order to get the lowest possible price. If you pick a plan or stick with Medicare, but your favorite doctor doesn’t accept it, the plan may not be the right one for you.

4. Does the plan place a cap on your out-of-pocket costs? Original Medicare does not limit what you can be required to spend out of your own pocket in a given year. On the other hand, healthcare reform required Medicare Advantage plans to place a limit of $6,700 or less on what they can ask you pay out of pocket for covered expenses in a single year. You can read more about the out-of-pocket maximum here.

5. How much does the plan cost each month? Original Medicare has a monthly premium determined by your income level, but the standard monthly premium is $115.40. Medicare Advantage plans will have this same cost and some (approximately 67%) will have an additional monthly premium above the Part B premium you already pay.

6. What is the Medicare Advantage plan’s star rating? The 5-star rating system is used by Medicare to monitor Medicare Advantage plans and determine if they meet certain quality standards.  The ratings also make it easier for someone on Medicare to compare plans based on quality and customer service. The star rating system considers 53 quality measures, such as success in providing preventive services, managing chronic illness, and keeping consumer complaints to a minimum. The higher the plan’s rating, the better. It’s not a bad idea to target plans that have a rating of 3.5 or higher.

Check Medicare Advantage Costs

(Click ‘here‘ to see a full list of Q&A’s on Medicare Advantage)

Medicare has not reviewed or endorsed this information

About Ross Blair


Ross Blair has applied more than 26 years of technology experience to develop PlanPrescriber.com, a website that makes it easier for seniors and their caregivers to select and enroll in the best Medicare products for their specific needs. In his role as CEO, he has worked closely with pharmacists, insurers, physicians, caregivers and seniors to identify the most critical and complex aspects of Medicare and create a system that delivers this information to consumers in a format that is easy to use and understand.

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