Medicare Advantage plans certainly differ from Original Medicare plans, but the answer of whether they’re better can vary from person to person.
While all Medicare Advantage plans must match or exceed Original Medicare’s coverage — of note, they tend to offer drug coverage, vision and hearing benefits, as well as extra perks, such as fitness memberships — there are also some possible drawbacks.
Medicare Advantage plans often require advance approval for many procedures and have a more limited network of providers than Original Medicare, so they may not be right for everyone — particularly people who want to see specific doctors or go to a certain hospital or care center. They also require you to live within the plan’s service area, so if you live in two different areas of the country throughout the year, you’ll want to stick with Original Medicare.
“The network of physicians and hospitals is much more regional than Medicare’s national network,” says Josh Hodges, chief customer officer at the National Council on Aging. “It’s important to verify that your preferred doctors and hospitals are in the plan’s network.”
In general, though, research finds that people who have both Original Medicare and Medicare Advantage tend to be equally satisfied with their care. While people on Medicare Advantage may have easier access to preventive care services such as vaccinations and routine checkups, people on Original Medicare had an easier time receiving care in the highest-rated hospitals for cancer care or highest-quality skilled nursing facilities.
“If you’re relatively healthy, a Medicare Advantage plan might make financial sense,” says Jennifer Wolff, PhD, of Johns Hopkins Bloomberg School of Public Health in Baltimore. “But if you’re managing chronic conditions and need specialty care, the wider provider network in original Medicare can become crucial to your decision-making.”
If you choose a Medicare Advantage plan and later decide to disenroll and select Original Medicare, you’re not guaranteed a right to buy a Medigap plan (except in limited situations), as is the case when you are first eligible for Medicare.
Here’s a further breakdown of some similarities and differences between the two:
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