Choosing Between a Traditional Medicare and a Medicare Advantage Plan

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Are you having trouble choosing a Medicare plan? Are you having trouble understanding the basis of the plans? Read the article below to understand the differences and see what questions you need to ask the provider when choosing the plan that is right for you. 

A traditional medicare plan is an open plan, so you can see the practices that take medicare. This means that you are eligible to see any specialist or primary care physician that is accepting medicare. You can also get a supplement in which medicare pays 80% of the bill, and a supplement insurance that will pay the 20% of the remaining balance. 

If you have an out of pocket maximum for your 20%, this can be infinite. So, if the treatment you are receiving is a lot of money; although medicare is paying 80%, you are still responsible for the 20%.

What you need to know for each plan is:

  • The yearly maximum
  • Your maximum, copay or deductible
  • Are they separate from pharmacy?
  • Is it separate for other services?

The trade off between the two plans is cost versus access. You will have more out of pocket expenses with traditional medicare rather than the advantage plan; but you will have access to whatever doctor you want to see. With medicare advantage you will get a closed network with lower copays, smaller deductibles, and lower out of pocket expenses, but this is because the doctors who are part of this program are within a closed network. 

A closed network is where there are only certain doctors you are able to see within that insurance plan. You would only have access to specialists within that specific network.

In the last few years, there have been a rise in smaller networks. This is to control costs while keeping the quality of care up. Be careful and understand the benefits of your plan before visiting the doctor or getting a plan.  

Make sure to ask questions when discussing these plans with the provider to understand all the advantages and coverage. We are currently accepting new patients and encourage you to call us to see if we accept your insurance plan!

 

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