Medicare Advantage Plan, Original Medicare Choices

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Medicare Advantage (MA) offers an alternative way of receiving your benefits through local or regional private plans, which are most often health maintenance organizations (HMOs) or preferred provider organizations (PPOs). Each plan must include everything covered by traditional Medicare, but may offer more benefits and/or lower copays. Most plans charge a monthly premium (in addition to the Part B premium), and most include Part D drug coverage. Your choice of doctors and other providers may be restricted to those in the plan’s network and geographical area—although PPOs allow you to go out of network for a higher copay. Each plan can, each calendar year, change its premiums, its extra benefits and its copays, or withdraw from Medicare You cannot buy a medigap policy to cover out-of-pocket costs in a Medicare Advantage plan. But each plan has an annual limit on out-of-pocket costs.
Source: aarp.org

Choosing Between Traditional Medicare and a Medicare Advantage Plan 

Costs in MA plans vary.  You must pay the same monthly premium as those enrolled in traditional Medicare Part B.  Additional out-of-pocket costs in an MA plan depend on what type of MA plan you choose and may include the following: whether the plan charges an extra monthly premium; whether the plan has a yearly deductible; how much you pay for each visit or service (copayments or coinsurance); the type of health care services needed and how often; and, whether network providers are used.  MA plans may charge cost-sharing for a service that is above or below the traditional Medicare cost-sharing for that service.  However, MA plans cannot impose cost-sharing for chemotherapy administration services, renal dialysis services, and skilled nursing care services that exceed the cost-sharing for those services under traditional Medicare.  All MA plans must have a maximum allowable out-of-pocket (MOOP) limit on the amount of cost-sharing they can charge for all Part A and Part B services, after which you will pay nothing for the rest of the year.  MA plans may also change benefits, premiums, and copays every year.
Source: medicareadvocacy.org

Traditional Medicare…Disadvantaged?

Craig’s experience raises important issues for consumers and policymakers.  Health insurance choices facing Boomers aging onto Medicare are complex, and may be hard to undo as medical needs and preferences change over time.  Craig’s story illustrates how current rules may disadvantage seniors who prefer traditional Medicare because they want greater control over their health care, but feel they need the financial protection of an out-of-pocket limit.  Under current rules, seniors are entitled to an out-of-pocket limit only if they sign up for a Medicare Advantage plan, but not if they choose traditional Medicare.  And, while seniors have the opportunity to switch from Medicare Advantage to traditional Medicare for any reason during an open enrollment season, they may be unable to protect themselves from unforeseeable costs by purchasing supplemental coverage if they have a medical problem.
Source: kff.org

Medicare.gov: the official U.S. government site for Medicare

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Source: medicare.gov

The Rising Cost of Living Longer: Analysis of Medicare Spending by Age for Beneficiaries in Traditional Medicare

Consistent with other studies documenting higher costs for patients at the end of life, this analysis shows that Medicare per capita spending was nearly 4-times greater among beneficiaries who died in 2011, on average, than among those who lived the entire year.  Yet the analysis also shows that Medicare per capita spending among decedents declines with age, suggesting that patients, families, and providers may be opting for less intensive and less costly end-of-life interventions for beneficiaries as they grow older.  This possibility is consistent with the finding that average per capita spending on hospice services among beneficiaries in traditional Medicare increases with age, due to both a larger share of beneficiaries electing hospice at older ages and higher per capita hospice costs for older than younger Medicare beneficiaries who elect hospice care.
Source: kff.org

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