Medicare Advantage Plans vs. Traditional Medicare

With Medicare Open enrollment beginning on October 15th, many seniors have tough decisions to make in choosing their healthcare plans. Medicare Advantage plans, often called Medicare replacement plans have become a very popular choice among seniors. I would strongly urge any senior to thoroughly exam all aspects of the Medicare Advantage plans and compare with the traditional Medicare plan offered by the government as there are very distinct differences which will affect your healthcare coverage.

Medicare Advantage plans are offered by private healthcare companies such as Humana and United and they are generally HMO’s or PPO’s. These plans have become popular for several reasons. Medicare Advantage plans often bundle dental and vision which traditional Medicare plans do not cover. Under traditional Medicare plans, you have to enroll in Part D for medication coverage and there is no option for dental.

Advantage plans also tend to have lower co-pays and monthly premiums. All these are wonderful things. However, what seniors do not often understand is the lack of coverage in many areas. Once enrolled in a Medicare Advantage plan, you are limited to a list of their network providers. Currently, our healthcare system is saturated with seniors seeking care. Many caregivers out there and seniors are seeing how difficult it can be to find physician’s accepting Medicare. Once finding these physicians, they are often booked for months as there are simply not enough physicians accepting Medicare to support the current aging population. The same is true with limited availability at many senior healthcare facilities. One can see that any limitations on providers in an already saturated healthcare system would be problematic.

The Medicare Advantage plans also tend to have limited coverage for some outpatient therapy services, mental health services, and for skilled nursing and rehab. It is very common that seniors will need to stay in a skilled rehab facility post hospitalization for therapy prior to returning home. Such reasons for admittance to a rehab facility for recovery include pneumonia, post hip and knee replacement surgery, heart attack and congestive heart failure, stroke, and falls resulting in injury. For times when a slow recovery is likely, it would be detrimental to have limited skilled nursing and rehab coverage. With this being said, one should really examine all aspects of both plans beyond just the financial. Many in good health will find these plans to be very desirable. However, if your condition suddenly changes limited coverage could put you in a very bad situation. To learn more about difference on Medicare Advantage plans and traditional Medicare you can refer to and the AARP website.

Laura Cayce is the Director of Care Management for CaraVita Home Care. She joined CaraVita Home Care in 2010 to manage and direct the company’s caregiving initiatives. She is an Alzheimer’s Association support group facilitator, and a member of the National Association of Social Workers, the National Association of Professional Geriatric Care Manager and the National Alzheimer’s Association.

6 Responses to “Medicare Advantage Plans vs. Traditional Medicare”

  1. A senior will need the Medicare plan that’s best for their conditions. This is very good reading for Medicare seniors. This will provide information what would be the best plan for each Individual.

  2. I would be interested in knowing if there is a combination Medicare coverage plan that would cover other areas that a senior would need related to their conditions. Maybe AARP Medicare. Some reading material could help on this type of plan. However, can a senior change their plan at anytime.

    • Laura Cayce, LMSW

      Unfortunately, traditional medicare plans do not cover dental or vision.You would have to enroll in Medicare part D for a medication plan and privately enroll in a dental or vision plan. The Medicare Advantage plans are beneficial in that they bundle medications, dental, and occasionally vision. However, they also have some downfalls as mentioned in my article. I would strongly advise you to enroll in a medicare supplement plan (also called medigap) which will pick up some of the costs original medicare will not cover like co-payments, coinsurance, and deductibles. Medicare part B covers 80% and Medigap plans will help pick up the rest of what is left over. You can refer to for choosing a medigap policy and for medicare related questions. The AARP website is also helpful.

  3. Joan Hebert

    very informative but am I to understand with medicare advantage, a senior having knee surgery cannot qualify for rehabilitation hospital care? Thank you

    • CaraVita Staff

      Each situation has to be checked with your plan because there are many variables that include complexity. Typically we see knee surgeries in snf rehab versus hospital but each case has to be evaluated to see what the other needs are as well.

  4. Brad Kittle

    I’m confused about the 20% that medicare would not pay and how it relates to an advantage plan. I notice that the advantage plans have caps on out of pocket in a year. Could you give an example of a typical procedure? For example if a knee replacement costs $9,000 through medicare the out of pocket of 20% would be $1800. Would the cost through an advantage plan be the same and would the out of pocket apply to the cap for the year?


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