Choosing between the Original Medicare and Medicare Advantage Plans has always been a tough task for most of the people due to all the complexities they bring with them. We can call this fight between the choices as Medicare Advantage vs. Medicare. According to federal law of U.S, the private insurance companies are bound to offer all those perks which are offered by the Original health insurance such as Medicare Part A and Part B. Moreover, according to the research, almost 90 percent of the Medicare Advantage Plans provide their members with prescription drug coverage. According to latest study, almost 68 percent of the health insurance Advantage members chose Health Maintenance Organization (HMO) plan whereas 27 percent chose Preferred Provider Organization and the reaming 5 percent chose other plans such as MSA and SNP, etc.
Generally, HMO plan requires that its members can only seek assistance from in-network service providers (doctors and hospitals) and also a referral from primary care doctor is needed to see a specialist. However, PPO plan allows its members to avail out-of-network Medicare-approved services but at higher rate. But Original Medicare is entirely different from Medicare Advantage because it allows all of its members to see any out-of-network doctor or visit any hospital for that matter. Medicare supplement plan G 2019
Pros and cons
Following are some of pros of health insurance Advantage Plans which have been gathered by Center for Medicare Advocacy:
- A very small amount of paperwork is needed due to less usage of claim submission.
- Healthcare Advantage Plans focus mainly on preventive care.
- These plans also offer supplemental benefits as compared to Original health insurance and those benefits are routine vision, hearing, and dental check-ups.
- You do not need to purchase any stand-alone package for drug coverage because health insurance Advantage plans are like a complete package.
- These plans have introduced a very amazing way of cost saving in form of maximum limit on out-of-pocket costs.
Now let us discuss some cons:
- Due to restricted network of service providers access to your favorite doctor, or hospital might be in jeopardy.
- Requirement to get referral from your primary care doctor to see a specialist slows down process.
- Less versatility in terms of dis enrollment or enrollment because once you enroll in health insurance Advantage Plans, then you will have to remain enrolled for a year. However, there are two exceptions one is an extra dis-enrollment period from January 1st to February 14th, and another one is enrollment period.