Medicare Your Coverage Options

If you want easy health care access and good quality care, you probably want traditional Medicare

Written by Diane Archer

When you’re considering your Medicare health plan options, if you want easy health care access and good quality care, you should seriously consider traditional Medicare. It is likely your only option that will ensure you get the care you want and need. Traditional Medicare generally covers your care hassle-free whenever you need it, wherever you are in the US.

Traditional Medicare with supplemental coverage offers the greatest choice of doctors and hospitals anywhere in America and allows you to budget for your health care. Supplemental coverage picks up most if not all of your Medicare out-of-pocket costs. Often, retiree coverage from a former job offers people this supplemental coverage. And, in many states, people with Medicaid can rely on Medicaid as their supplemental coverage.

If you don’t have retiree coverage or Medicaid, you can buy Medicare supplemental coverage or Medigap in the individual market. The cost can easily be $250 a month, which is significant. But, for anyone who ends up in the hospital, choosing traditional Medicare and buying supplemental coverage generally allows you to: 1. See the doctors you know and trust wherever you are in the US with little or no out-of-pocket costs, 2. Receive whatever care your doctors think you need, and 3. Keep your health care costs down.

In sharp contrast to traditional Medicare, a Medicare HMO or other private Medicare Advantage plan 1. restricts your access to doctors and hospitals, 2. determines what care they will cover, and 3. can leave you responsible for paying hundreds or even thousands of dollars every time you need care.

To be clear, upfront costs for Medicare HMOs and other Medicare Advantage plans are generally lower than those for Medicare supplemental coverage. But, there’s absolutely no way to budget for your care. You cannot know whether a private Medicare Advantage plan with a limited network of doctors and hospitals will meet your unforeseeable care needs—the care you want at a price you can afford from doctors and hospitals you want to use, wherever you are in the US.

For example, with rare exceptions, in a Medicare Advantage plan, you will not have coverage outside your community, you will not have coverage from doctors outside the health plan’s network, and you may find that high deductibles and copays as well as health plan denials of coverage prevent you from getting the care you need. For costly care, you will generally need to go through a prior authorization process, during which your plan will decide whether it will cover your care.

With a Medicare Advantage plan, if you need costly services you could end up spending as much as $6,700 out of pocket for in-network services alone.  And, you will likely end up spending far more if the doctors and hospitals you use are out of network; in those cases, you will generally be liable for the full cost of their care. Moreover, if you are hospitalized, it’s more than likely that some of your doctors will be out of network. (Here are four things to think about when choosing between traditional Medicare and a Medicare Advantage plan.)

Kaiser Family Foundation study examines the literature comparing access and quality in traditional Medicare and Medicare Advantage plans. The data is limited.  But, not surprisingly, data from people with complex and costly conditions rate the private Medicare Advantage plans “substantially lower” than traditional Medicare on access and quality.

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