AARP Hearing Center
Key takeaways
- Consult expert Tricia Sandiego’s tips to compare Medicare coverage options before enrolling at 65.
- Maximize provider flexibility and nationwide access with Original Medicare, as Tricia Sandiego recommends.
- Weigh extras like dental, vision and drug coverage in Medicare Advantage plans with Tricia Sandiego’s guidance.
Summary
Deciding between original Medicare and Medicare Advantage is a key step for anyone approaching age 65. According to Medicare adviser Tricia Sandiego, understanding the differences can help you make a confident choice that fits your health needs and lifestyle. With original Medicare, you’ll have broad provider access nationwide and don’t need referrals for specialists, though you may want supplemental plans to cover things like prescription drugs and limit out-of-pocket costs. Medicare Advantage plans may offer extras like dental and vision coverage, and they often include prescription drug coverage, but typically require you to use a local provider network and get referrals for specialty care.
Choosing the right Medicare plan matters not just for coverage but for your overall costsand flexibility. If you travel often, original Medicare allows you to see providers anywhere in the country who accept Medicare, while Medicare Advantage plans may limit coverage to your local area. Weigh your options carefully and be sure to review what’s covered, what isn’t, and how costs work for each plan. For more in-depth guidance and helpful tools, visit aarp.org/medicare
The key takeaways and summary were created with the assistance of generative AI. An AARP editor reviewed and refined the content for accuracy and clarity.
Full Transcript:
[00:00:00] One of the things that people get hung up on the most when signing up for
Medicare is whether they should pick original Medicare or Medicare Advantage.
[00:00:08] There are a lot of aspects to consider, but don’t worry. I’m here to help. Hi, I’m
Tricia Sandiego.
[00:00:14] In my work with AARP, I help people understand the ins and outs of Medicare.
[00:00:20] Let’s take a look at the differences between original Medicare and Medicare
Advantage To start, it’s important to note that both options offer basic health care coverage.
[00:00:33] That’s your hospital stays, doctor visits and diagnostic tests. But there are
differences, especially when it comes to access to providers,
[00:00:41] costs and how each plan is run. Here’s the easiest way to think about it. Original
Medicare is run by the federal government.
[00:00:48] Medicare Advantage is a private health insurance alternative, but companies
must be approved by the government and follow strict rules.
[00:00:56] Now, let’s talk a little bit about differences when it comes to access to providers.
Original Medicare lets you see any doctor or health care provider who
[00:01:05] takes the program. You won’t need a referral to see a specialist. I’ll talk more
about that in a minute.
[00:01:11] Medicare Advantage plans work like insurance you may have through your
employer. In most cases, you’ll have a primary care provider who must be in network
[00:01:21] depending on which plan you go with. Your plan may also require you to get a
referral from your primary care
[00:01:27] provider before seeing a specialist. If you see a provider outside the plan’s
network, you may wind
[00:01:34] up paying more for your coverage. It’s also possible that your plan may not pay
at all, so make sure you know if
[00:01:41] that’s a possibility before you get too far down the road with a given provider.
And there’s more. With original Medicare,
[00:01:48] you can see any doctor anywhere in the country who takes Medicare. Medicare
Advantage plans typically operate in specific geographic areas.
[00:01:57] If you travel a lot or live part of the year in another part of the country, your
coverage may not extend outside of your plan’s local area,
[00:02:05] with the exception of emergency care. So check your plan’s rules to be sure
you’re prepared and covered.
[00:02:12] OK, so how do you know what’s covered and what’s not under each option? Let’s
look at some specifics.
[00:02:19] Both original Medicare and Medicare Advantage plans cover the same basic
health care services to meet your medical needs, but costs can be different.
[00:02:28] Original Medicare does not cover some needs like routine vision, dental and
hearing care.
[00:02:35] Medicare Advantage plans, however, may at least partially include them. You can
buy a separate private insurance plan for these services if needed.
[00:02:44] One very big thing to consider is your coverage for prescription drugs, which is
really important to have, especially as you get older.
[00:02:52] If you choose original Medicare, prescription drugs are not included. You’ll need
to enroll in a separate plan under a part of Medicare called
[00:03:00] Medicare Part D. If you go with Medicare Advantage, most plans already include
[00:03:06] Part D prescription drug coverage. OK, let’s look at cost scenarios. It’s important
to know that original Medicare requires cost sharing for many
[00:03:16] services and does not limit how much you may have to pay for these costs. This
unpredictability is why most people with original Medicare
[00:03:25] also have supplemental coverage. For example, a Medigap policy you purchase
on your own, a retiree plan
[00:03:32] offered by a former employer or Medicaid for people who qualify. In general,
each Medicare Advantage plan determines in advance how much
[00:03:42] you pay when you use a covered service. All plans have an annual limit for how
much you pay in total, which
[00:03:48] makes it easier to anticipate costs. Here’s one last thing to keep in mind if travel
is a part of your lifestyle.
[00:03:56] Neither original Medicare nor Medicare Advantage will cover your health care
when you leave the country.
[00:04:01] Some Medigap plans, like the ones I mentioned earlier, offer some foreign travel
emergency coverage, as do some Medicare Advantage plans.
[00:04:10] So you’ll definitely wanna look into this to be sure you’re covered before you
take your next trip abroad. For more helpful information, visit AARP dot org slash medicare.
