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The Advantages and Disadvantages of Medicare

Once you qualify for Medicare, you have several options when it comes to enrolling in a plan. You can enroll in Original Medicare, you can replace Original Medicare with a Medicare Advantage plan, or you can enroll in a Medicare Supplement Insurance plan to help offset some of Original Medicare’s out-of-pocket costs.

Below, we evaluate the advantages and disadvantages of each option to help you choose a Medicare plan that works for you.  

Original Medicare

Original Medicare is administered and managed by the federal government. The two parts of Original Medicare (Part A and Part B) each provide coverage for different health care services.

Medicare Part A (hospital insurance) covers inpatient care, including care received in a hospital and skilled nursing facility. 

Medicare Part B (medical insurance) covers doctors services, outpatient services, laboratory tests, preventive care and durable medical equipment.

Advantages

The main advantages of enrolling in Original Medicare include:

  • Low monthly premiums

Medicare Part A is usually premium free for most people, and the standard premium for Part B starts at $135.50 per month in 2019 (but can be higher based on your income). Most people who receive Social Security benefits can expect to pay an average of $130 per month for their Medicare Part B monthly premiums in 2018.

  • Broad acceptance

Medicare offers a wide range of flexibility when it comes to choosing a healthcare provider. According to a recent study by the Henry J. Kaiser Family Foundation, more than nine out of 10 doctors accept Medicare.1

Disadvantages 

Despite the advantages of enrolling in Original Medicare, the program also has disadvantages, which include:

  • Out-of-pocket costs

Even after meeting your deductibles for premium-free Part A ($1,364 per benefit period in 2019) and Medicare Part B ($185 per year in 2019), the out-of-pocket costs associated with Medicare can add up rather quickly in the form of coinsurance and copays. Medicare Part B, for example, typically covers 80% of your medical costs, but you may be responsible for covering the remaining 20%.

  • No vision, dental or hearing benefits

If you receive a routine hearing test, or if you visit an eye doctor or a dentist, Original Medicare generally will not cover the cost.

Medicare Supplement Insurance

Also called Medigap, Medicare Supplement insurance plans are sold by private insurance companies. Medigap plans do not replace your Original Medicare benefits. Instead, they work in tandem with Medicare Part A and Part B to give you more comprehensive and predictive coverage.

Advantages

The main advantages of enrolling in a Medigap plan include:

  • Broad coverage

All 10 standardized Medigap plans provide at least partial coverage for:

    • Medicare Part A coinsurance and hospital costs
    • Medicare Part B coinsurance or copayment
    • First three pints of blood 
    • Hospice care coinsurance or copayment
  • Numerous plan options

In most states, there are 10 standardized Medigap plans to choose from, each providing a different level of basic benefits. This means there are plenty of options to ensure you find a Medigap plan that provides the level of coverage you need. Medigap plans with comprehensive coverage (such as Medigap Plan F) are more expensive, whereas Medigap plans with less comprehensive coverage (such as Medigap Plan A) are less expensive.

For a side-by-side view of all 10 standardized plans, refer to the chart below.

Medicare Supplement Benefits A B C D F1 G K2 L3 M N4
Part A co-insurance and hospital costs
Part B co-insurance or co-payment 50% 75%
First 3 pints of blood 50% 75%
Part A hospice care co-insurance or co-payment 50% 75%
Co-insurance for skilled nursing facility     50% 75%
Medicare Part A deductible   50% 75% 50%
Medicare Part B deductible              
Medicare Part B excess charges              
Foreign travel emergency     80% 80% 80% 80%     80% 80%
1. Plan F offers a high-deductible plan. This plan requires you to pay a $2,300 deductible in 2019 before it covers anything. 2. Plan K has an out-of-pocket yearly limit of $5,560 in 2019. After you pay the out-of-pocket yearly limit and yearly Part B deductible, it pays 100% of covered services for the rest of the calendar year. 3. Plan L has an out-of-pocket yearly limit of $2,780 in 2019. After you pay the out-of-pocket yearly limit and yearly Part B deductible, it pays 100% of covered services for the rest of the calendar year. 4. Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in an inpatient admission.

Disadvantages

Although Medicare Supplement Insurance is a great option for many, it can have some disadvantages for some:

  • They are unavailable to those enrolled in Medicare Part A only

Medicare recipients who are not enrolled in Medicare Part B are not eligible to enroll in a Medicare Supplement Insurance plan. In most cases, you become eligible for a Medigap plan when you are both 65 and enrolled in Medicare Part B.

  • They may be unavailable to those who are younger than 65

Federal law does not require insurance companies to sell Medigap policies to people younger than 65, but some state laws do. Even if you are granted a Medigap policy, however, you could pay higher premiums if you are younger than 65. 

Medicare Advantage

Also known as Medicare Part C, Medicare Advantage plans are sold by private insurance companies to replace the Part A and Part B benefits that are provided by the federal government. By law, these plans are required to offer the same benefits as Original Medicare (with the exception of hospice care).

Advantages

Some advantages of enrolling in Medicare Part C:

  • Additional Benefits are sometimes provided

Although Medicare Advantage plans must provide the same benefits as Original Medicare, some of them provide additional benefits such as dental, vision and prescription drug coverage. 

  • There are many types of plans to choose from

Medicare Advantage plans come in a wide variety of forms, including health maintenance organization (HMO) and  preferred provider organization (PPO) plans.

Disadvantages

Depending on your situation, the disadvantages of Medicare Part C may outweigh the advantages. Some of the main disadvantages of Medicare Advantage include:

  • Strict coverage rules

Many Medicare Advantage plans do not permit you to seek care from a physician outside of your plan’s predetermined network of health care providers (unless it is considered an emergency). Other Medicare Advantage plans allow you to go outside of the network, but charge you a much higher price for the service.

  • You may lose your plan if you move

Not all Medicare Advantage plans are available in every area. If you move to an area that is not covered by your Medicare Advantage plan, you must enroll in a different Part C plan or enroll in Original Medicare. If you switch Medicare plans, your physician my no longer be in your plan’s network.

A licensed agent can help you decide on a Medicare option that works for you. Speak with a licensed agent at 888-264-0148, or read through our helpful guide, 10 Medicare Mistakes You Could Be Making.

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Sources:

1 http://kff.org/medicare/issue-brief/primary-care-physicians-accepting-medicare-a-snapshot/

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