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Turning 65? Decision Time: Original Medicare vs. Medicare Advantage

Updated: Oct 24

Reasons for choosing Original Medicare over Medicare Advantage

Doctor choice

Medicare Advantage approves or rejects your visit to a specialist. They will not cover a visit to a doctor out of their plan’s network. They require “prior authorization”.

Original Medicare means you can go to any specialist, lab, or hospital that participates in Medicare (90% of medical professionals do). Original Medicare has a wider choice of doctors.

Better Drug Coverage

As retirees age, they don’t know what drugs they’ll need in the future. Original Medicare with Part D coverage is more likely to cover new medications and medications the retiree didn’t initially need. A Medicare advantage plan may not approve a new drug treatment.

More security as you age

MA plans seem fine as long as you’re healthy. But too often, beneficiaries with serious illnesses find it more difficult to get the care they need.

More predictable coverage

If you have chosen a Medicare Advantage plan and then decide you want to switch to Original Medicare, you might get rejected for Medicare PartD (drug) or Medigap coverage if you have a pre-existing condition.

Reasons for choosing a Medicare Advantage plan

Premiums are usually lower.

It’s simpler. Fewer parts to pay for. With Original Medicare you’ll want to buy a Medigap policy or a separate Part D prescription plan. If you can’t afford those parts, you’re more likely to prefer a Medicare Advantage plan because of the lower initial month-to-month premium.

More extras

An Advantage plan may include gym memberships, regular dental or optical visits, or transportation to doctors’ offices.

Out of pocket limits

In 2023, MA enrollees know they won’t have to pay more than $8,300 in total annual health costs, although many plans have lower out-of-pocket limits than that. Original Medicare has no out-of-pocket annual cap.

Advantage plans are marketed better

Advantage plans are marketed by businesses with more advertising and celebrity endorsements.

Your consultant is compensated by commissions for Medicare Advantage Plans

Your consultant has minimal financial incentive to show you the drawbacks of Medicare Advantage. There are no commissions for an Original Medicare policy. It’s a government plan.

Source: All of these notes were excerpted or summarized from this article in AARP Bulletin. The article also has a nice glossary of terms in the footnotes.

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