When enrolling in Medicare, patients have two options for medical, hospital, and prescription drug coverage:
They can choose to receive medical and hospital coverage through "Original Medicare" (Parts A and B) and enroll in a stand-alone Medicare Part D plan (PDP). They also have an option to sign up for Medigap plan to help cover certain expenses such as deductibles and coinsurance.
They can sign up for a Medicare Advantage plan, also known as "Part C," which is a combination of medical, hospital, and drug (A, B, and D) all in one plan. Advantage plans are run by private companies that contract with Medicare. The patient would still have Parts A and B through Medicare, but they would receive all of their medical, hospital, and drug coverage through this private company. These plans are also known as MA-PDPs.
Here are some pros and cons for each:
Pros of Original Medicare with a stand alone Part D plan (PDP):
• The patient can see any doctor or go to any hospital that is contracted to accept assignment with Medicare. This option allows the broadest possible choices in doctors and other providers.
• Patients don't need prior approval or a referral to see a specialist or have a procedure.
• Patients can mix and match with Medigap and Part D coverage as they so desire.
Cons of Original Medicare with a stand-alone Part D plan:
• Original Medicare (Parts A and B) has deductibles and a 20% coinsurance for medical and hospital coverage. If someone sees many doctors or requires hospitalization, and they don't purchase a Medigap plan, it can be expensive.
• Original Medicare does not cover vision, dental, or hearing. The patient would need to sign up for a separate supplement.
Pros of Medicare Advantage Plans:
• Advantage plans usually have set copays for doctor appointments, hospitalization, and other services.
• They have an out-of-pocket max for hospital and medical coverage.
• Many (but not all) advantage plans offer dental, hearing and/or vision coverage.
Cons of Medicare Advantage plans:
• Advantage plans have limited doctor and hospital networks. The patient would need to make sure their current providers are in network with the plan.
• Advantage plans usually require a referral to see a specialist and prior approval by the plan for medical procedures.
Looking to compare plans? Here is a step by step guide.