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Weigh Your Medicare Coverage Options

Pros and cons to consider when deciding your insurance mix

Medicare pros and cons

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Each Medicare option offers benefits and drawbacks, so it is important to weigh them carefully.

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Original Medicare 

(Parts A and B)

Pros

  • You have more choices for doctors and hospitals. 
  • You don’t have to worry about your plan shutting down or leaving town.
  • You don’t need referrals for specialists.
  • Premiums are set by the federal government, not a private company.
  • Coverage is not limited to your local region.

Cons

  • Monthly premiums can be higher than Part C if you need a Medigap plan.
  • If you have serious medical conditions, your out-of-pocket costs could be higher (there is no out-of-pocket spending limit). 
  • Separate plans to cover drug costs and other health expenses can add complexity to your health care arrangements.


Medicare Advantage 

(Part C)

Pros

  • One-stop shopping — there is no need to get separate drug or supplemental policies in most Part C plans.
  • Some plans cover dental, vision and hearing.
  • A primary care physician may coordinate your overall health care needs. 
  • Plans typically have lower cost sharing than original Medicare.  

Cons

  • You may pay more for going to doctors or health care centers out of network.  
  • You may need referrals to see specialists.
  • If your plan leaves the area or shuts down, you have to choose new coverage. 
  • Some plans charge an additional premium above the standard Part B premium.

Plans are difficult to compare, as no two are the same.

Supplemental Insurance 

(Medigap)

Pros

  • It covers some or most out-of-pocket expenses that parts A and B don’t, including hospital deductibles and 20 percent doctor-visit coinsurance.
  • You are guaranteed coverage during the initial enrollment period, even if you have a preexisting condition. Coverage is then guaranteed renewable, as long as you pay your premiums.
  • As with original Medicare, coverage is nationwide. 
  • Plans are standardized by the federal government, making them easy to compare.

Cons

  • Average premiums are more than $2,000 a year.
  • Once enrolled, it may not be easy to switch plans.
  • If you don’t sign up during the initial enrollment period, plans can deny coverage or charge higher rates. 
  • There is no prescription drug coverage, so you still have to enroll in a Part D plan.

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