Nearly 63 million Americans were enrolled in Medicare in December 2020.1
Such a large number of beneficiaries rely on some type of Medicare health coverage, but what are some of the benefits and drawbacks Medicare beneficiaries may face?
This guide takes an in-depth look at both the advantages and disadvantages of Medicare. We look at the potential benefits and disadvantages of:
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Some of the potential advantages of Original Medicare coverage include:
Most people receive Medicare Part A (hospital insurance) without having to pay a premium.
Medicare Part B (medical insurance) is optional. The standard Part B premium is $170.10 per month in 2022.
By comparison, the average benchmark premium cost of a Silver plan under the Affordable Care Act (Obamacare) marketplace is $452 per month in 2021.2
To be eligible for Medicare Part A and Part B, you typically must be:
Medicare is accepted by more than 90 percent of physicians.3
Medicare may be used in all 50 states and the District of Columbia. Medicare Part A and Part B overage can also be used in:
Original Medicare can include a few disadvantages, which can include some of the following.
Medicare Part A and Part B cover a wide range hospital and medical benefits, but they still leave many things not covered.
Original Medicare doesn’t typically cover items or services such as:
In order to get coverage for some of the benefits listed above, Medicare beneficiaries can consider enrolling in a Medicare Advantage plan that includes some or all of these benefits.
Medicare Part A and Part B include out-of-pocket costs that beneficiaries should consider.
Medicare beneficiaries can consider enrolling in a Medicare Supplement Insurance plan that can help cover some of their out-of-pocket Medicare costs, such as certain deductibles and copayments.
Original Medicare does not have an out-of-pocket limit. This means that Medicare beneficiaries have no limit to the amount of money they may be required to pay out of their own pocket for covered health care services in a single year.
All Medicare Advantage plans include an out-of-pocket spending limit.
Certain Medicare Supplement Insurance plans also include an out-of-pocket spending cap.
Medicare Advantage plans are an alternative to Medicare Part A and Part B. Medicare Advantage plans must cover at least the same benefits as Original Medicare.
You can also choose from different types of Medicare Advantage plans, such as health maintenance organization (HMO) plans and preferred provider organization (PPO) plans, depending on where you live.
Some Medicare Advantage plans also offer $0 monthly premiums, and all Medicare Advantage plans include an annual out-of-pocket spending limit.
Find $0 premium Medicare Advantage plans in your areaCompare Plans
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Medicare Advantage plans and Medicare Supplement Insurance (Medigap) are not the same thing. You cannot have a Medicare Advantage plan and a Medigap plan at the same time.
If you're choosing between Medicare Advantage vs. Medicare Supplement plans, you may want to consider the following:
If you prefer lower or no coinsurance and copay costs in exchange for higher monthly premiums, you may want to consider a Medicare Supplement plan.
If you prefer to pay low or $0 monthly premiums and don't plan on receiving frequent health care services, you may want to consider a Medicare Advantage plan.
A licensed insurance agent can help you compare your options and discuss your eligibility for different types of Medicare plans.
Medicare Supplement Insurance plans can help cover certain Medicare deductibles, coinsurance, copayments and other out-of-pocket expenses faced by Medicare beneficiaries.
One advantage of Medigap plans is that all 10 standardized Medigap plans that are sold in most states cover Medicare Part B coinsurance or copayments, at least partially.
Depending on the types of Part B services you receive and how often you need them in a year, this could help save you money.
Another advantage of Medigap plans is that they are accepted by every doctor and health care provider who accepts Medicare.
One disadvantage of Medicare Supplement insurance is that insurance companies aren’t required to sell Medigap policies to people younger than 65.
Some states do require insurance companies to sell Medigap to people under 65, but even in those cases, you could pay higher premiums if you are younger than 65. Check with your state’s department of insurance to learn more about Medigap rules where you live.
A licensed insurance agent can help you compare Medicare Advantage plans that are available in your area.
You can review information such as plan costs, prescription drugs that might be covered by the plan and whether your doctor is part of the plan’s provider network.
Find Medicare Advantage plans in your areaCompare Plans
Or call TTY Users: 711 24/7 to speak with a licensed insurance agent.
1 Centers for Medicare and Medicaid Services. Medicare Enrollment Dashboard. Retrieved Dec. 2020, from www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Dashboard/Medicare-Enrollment/Enrollment%20Dashboard.html.
2 Kaiser Family Foundation (KFF). Average Marketplace Premiums by Metal Tier, 2018-2021. Retrieved Dec. 2020 from https://www.kff.org/health-reform/state-indicator/average-marketplace-premiums-by-metal-tier.
3 Boccuti, Cristina; Fields, Christa; Casillas, Giselle; Hamel, Liz. Primary Care Physicians Accepting Medicare: A Snapshot. KFF. (Oct. 30, 2015). Retrieved from www.kff.org/medicare/issue-brief/primary-care-physicians-accepting-medicare-a-snapshot.
Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.
Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.
Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.
A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.
If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.