Medicare Open Enrollment - Know Your Facts | Community HealthCare System

Original Medicare vs. Medicare Advantage

Medicare open enrollment is scheduled to run Oct. 15 to Dec. 7. That’s when seniors can switch coverage between Original Medicare and Medicare Advantage, or change a prescription drug plan.

At first glance, it may be easy to see the appealing parts of Medicare Advantage. Original Medicare includes Part A, for in-patient hospital and skilled nursing care, and Part B, for doctor services. These plans typically cost about $165 a month (with the cost deducted from your social security check). Many people pay extra for Medigap, to cover copays and other out-of- pocket costs, as well as a Part D plan for drugs.

Medicare Advantage plans (also called Part C), provide the benefits of Part A, B, and often D, usually for about the same amount, with lower copays, so there’s no need for Medigap. Some Medicare Advantage plans offer benefits not in Original Medicare, such as fitness classes or vision and dental care.

This often sounds good – but review the details closely. Choosing between the two requires careful consideration of your finances and health needs. Medicare Advantage plans can carry hidden risks, especially for people with major health issues. Some people in Medicare Advantage may end up paying unexpectedly high costs when they become ill or find that their network lacks the providers they need.

With Original Medicare you can see any provider who accepts Medicare, which is most. However, Medicare Advantage plans typically require that you get care from a more limited network of providers, and in most cases, you will need a pre-authorization from the insurance payer to see specialists, receive Part B drugs, get skilled nursing facility stays or inpatient hospital stays, receive mental health services or receive diagnostic services such as procedures, labs, tests, therapy, dialysis, hearing, eye exams, dental care and many other services.

A recent Kaiser study found that about half of all Medicare Advantage enrollees would end up paying more than those in Original Medicare for a seven-day hospital stay.

Medicare Advantage plans may be especially problematic for people in rural areas. A 2021 study found that rural Medicare Advantage plan enrollees were nearly twice as likely to switch back to Original Medicare as those in urban areas. The network of providers in rural areas are especially narrow, making it harder for people to get care.

If you have questions about Medicare or other senior insurances, please contact Angie Sauvage at 785-889-5054, or your local Area Agency on Aging.

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