When deciding between Traditional Medicare and Medicare Advantage, the goal is to future-proof your decision as much as possible.
It’s a big decision. And it’s a hard one to make when future health status and needs are unknown. No one wants to assume they will develop a serious health condition or require extensive care, but choosing Medicare coverage today can affect how and if you get needed care in the future.
If you’re newly eligible for Medicare or helping a family member with their new coverage choices, there are three factors to consider today that may help for the future:
- While Medicare Advantage plans must cover everything Traditional Medicare does and may include additional benefits like dental, vision, and hearing, there can be significant limits to this coverage.
Medicare Advantage plans can limit a patient’s number of covered visits. They can also limit the care setting. And, coverage is not guaranteed, even if your physician says you need a particular treatment, medication, or service. Nearly all Medicare Advantage plans require your doctor to get their approval for care before you receive it. Known as “prior authorization”, this process can take several days or longer, which can delay treatment, and there’s no guarantee approval will be given.
- Medicare Advantage plans typically require enrollees to use their chosen network of preferred doctors, hospitals, therapists, and home health providers. These networks may not include providers in our community. You might have to drive an hour away or more to see an in-network provider.
In addition, Medicare Advantage plan networks can change year over year so a provider you rely on today may not be available to you tomorrow. If you have a chronic condition that requires ongoing management and care from multiple specialists, any disruption in provider availability can be serious.
- Consider the cost of supplemental, or MediGap, coverage. When you first become Medicare-eligible, you can enroll in Traditional Medicare and purchase MediGap coverage to help cover some of your out-of-pocket health care costs like deductibles and copayments. The cost of a MediGap policy cannot factor in your health status, and you cannot be denied coverage because of pre-existing health problems. Coverage is renewed automatically each year, and it cannot be dropped because of health problems.
However, if you enroll in a Medicare Advantage plan, develop a chronic condition or other health care need requiring different services, and decide you want to switch back to Traditional Medicare because your plan doesn’t cover what you need, you might find the cost of MediGap coverage out of reach or unobtainable. That’s because those policies are now priced based on your health risk, and insurance companies don’t have to issue you a policy.
No one wants to think about needing health care or getting sick. But, the chances of developing a serious health condition are greater as we age. Medicare Advantage might look on the surface like the best deal, but in the long-run, traditional Medicare has the most protections.
