When we get a wedding invitation we are often asked to pick between two choices: Chicken or steak? But if we wished we made the other choice, it’s no big deal. The bride still looks great, we still have all our old dance moves, and heck it’s only a meal.
On the other hand, Medicare Advantage or Original Medicare is not chicken or steak. Our future health, the medical issues we could have now, could have next week, or most likely will have in the future, and how we deal with them, is at stake.
Medicare rules for healthcare agents do not allow me to discuss the extra bene?ts of Medicare Advantage plans in this format but for most people Medicare Advantage plans will often come with extra bene?ts that Original Medicare does not have. Medicare Advantage will usually cost you less in premiums and in your total amount spent. Although, with Medicare Advantage you do have co-payments, which with hospital stays and cancer treatments especially, can get costly. However, you are protected by a maximum-out-of-pocket amount, we agents call it MOOP, after which you have no further copayments to make for the rest of the calendar year. This way, you do know your downside. Medicare Advantage plans, which can be HMOs or PPOs work beautifully for a lot of people. Many people will tell me they saved a lot of money by going with Medicare Advantage.
That said, the most common question I get, in fact I have been asked it hundreds of times is, “Which one am I on, myself?” My own choice, and my reasons for it, may be very di?erent than how others weigh it. But I am on Original Medicare with a Medigap supplement. If it costs me more each year than Medicare Advantage would, then I don’t mind. The car I choose to drive also costs me more than a more economical choice would. Not all my choices are about what gets me the best value.
There are two reasons I chose Original Medicare with a Plan G supplement. My first reason is that with Original Medicare I can see any doctor, or go to any clinic or hospital, in the USA that takes Medicare.
Maybe, if I get some exotic disease I will want to travel to a hospital somewhere else that specializes in my disease. Chances are I won’t, but my point is I don’t want to be told that I can’t. The majority of doctors and hospitals take a large percentage of Medicare Advantage plans, but there are some doctors and clinics that take only Original Medicare and I don’t want to be restricted.
With Original Medicare I can do my own homework and make my own appointments with specialists with less concern as to whether they will be in network. Because with Original Medicare there are no doctor networks. If a doctor or clinic takes Medicare at all, then I can see them.
The second important reason for my own choice of Original Medicare, is that Medicare Advantage plans often require pre-authorizations. Medicare Advantage carriers want the right to pre-approve before paying out a lot of money on expensive medical procedures. Original Medicare is not a “ticket to anything medical at all you want” but to the degree there are any authorizations needed, or that may be required by rule changes in the future, these restrictions are much fewer with Original Medicare.
The choice, often comes down to Less Cost on one hand, versus More Freedom and Flexibility on the other. I can’t tell you which should be more important to you. My own clients choose between the two options right around 50/50.
My recommendation is to think about Medicare, and the coverage that you will want, based upon “someday”. Today you may be 100% healthy, or close to it, but that can change at any moment. If you were to have a major medical issue where you could not switch to Original Medicare with a Medigap supplement, would you be happy with Medicare Advantage? Or, would you want the extra freedom and ?exibility of Original Medicare? If your own answer to the “someday” question is Original Medicare my advice is to not play chicken with possibilities, and make that choice now, even if it saves you money to go with Medicare Advantage now with the plan of switching later.
