When you turn 65, you come to a fork in the road. You must choose how to receive your Medicare benefits. Path 1: Original Medicare (managed by the federal government). Path 2: Medicare Advantage (managed by private insurance companies).
Neither is "better" for everyone. The right choice depends entirely on your health, your budget, and how much you travel.
Path 1: Original Medicare (The "Fees-For-Service" Model)
This includes Part A (Hospital) and Part B (Medical). Most people on this path also buy a Medigap (Supplement) policy and a Part D (Drug) plan to flesh out their coverage.
Pros:
- Doctor Choice: You can see any doctor or specialist in the U.S. who accepts Medicare (which is most of them). No networks.
- No Referrals: You don't need permission from a primary care doctor to see a specialist.
- Predictable Costs: If you have a Medigap plan, your out-of-pocket costs are virtually zero. You pay your premium, and the insurance pays the bills.
Cons:
- Higher Premiums: You have to pay the Part B premium + Medigap premium + Part D premium. This can add up to $300-$400+ per month.
- No "Extras": Original Medicare generally doesn't cover dental, vision, or hearing.
Path 2: Medicare Advantage (Part C)
These are private plans (HMOs or PPOs) that bundle Part A, Part B, and usually Part D into one card.
Pros:
- Low Premiums: Many plans have $0 monthly premiums (you still pay the Part B premium to the government).
- Extra Benefits: Most plans cover dental cleanings, eye exams, hearing aids, and even gym memberships (SilverSneakers).
- Convenience: One card, one bill.
Cons:
- Network Restrictions: You usually must see doctors in the plan's network (HMO). If you go out of network, you pay more or the full cost.
- Prior Authorization: The insurer can require you to get approval before they pay for certain procedures or tests.
- Pay-as-You-Go: While premiums are low, you will pay copays for every doctor visit ($10-$50) and hospital stay ($300+/day) until you hit an out-of-pocket maximum (which can be over $8,000).
Which Should You Choose?
Choose Original Medicare + Medigap if:
- You travel frequently or live in two different states (snowbirds).
- You have serious health conditions and want to see the best specialists nationwide without referrals.
- You prefer paying a higher monthly premium to avoid surprise bills later.
Choose Medicare Advantage if:
- You are generally healthy and don't see doctors often.
- You are on a tight monthly budget and can't afford Medigap premiums.
- You want the "extras" like dental and vision included.
Comparison Table
| Feature | Original Medicare + Medigap | Medicare Advantage |
|---|---|---|
| Doctor Access | Any doctor in U.S. | Network limits (HMO/PPO) |
| Referrals | No | Often Yes |
| Monthly Cost | High | Low / $0 |
| Out-of-Pocket | Very Low | Higher copays |
| Dental/Vision | No | Yes |
Your health needs change. The good news is you can switch plans during the Annual Enrollment Period (Oct 15 – Dec 7) every year. Review your Medicare options now.