Medicare Advantage or Original Medicare? Understanding the Differences Is Key for Kansas Senior
As a physician serving our community, Arlo Reimer, M.D., understands the challenges seniors face when it comes to accessible, affordable health care. Choosing the right Medicare health plan helps overcome those challenges, but how do you know which plan is best when there are different cost and coverage options to choose from? During open enrollment (Oct. 5-Dec. 7), making the right choice for you starts with knowing the differences between Original Medicare and Medicare Advantage.
Original Medicare is a federally funded program that offers broad access to health care providers nationwide. Beneficiaries can see any doctor or visit any hospital that accepts Medicare, offering flexibility and peace of mind. Medicare Advantage plans (which are offered by private insurers) cover the same services as original Medicare, but do not offer that same flexibility and peace of mind as most services require prior authorization which many times limits access to services ordered by your provider.
While Advantage plans often include additional benefits (like discount drug programs, vision and dental coverage, and even healthy amenities like wellness plans or gym memberships) and often have lower premiums than Original Medicare, additional costs may arise, like copayments, coinsurance, and deductibles, which can vary significantly between plans.
Another consideration, specifically for seniors living in rural areas like Pawnee County, is that Medicare Advantage plans require beneficiaries to rely on in-network doctors and hospitals, which can be more convenient and affordable for some – but not all. For patients in medically underserved areas of Kansas, limited provider networks can be a significant barrier to care.
Medicare Advantage plans also negotiate reimbursement rates with providers and health systems, which are often lower than Original Medicare rates. That may not seem like a concern for patients, but there’s a hidden ripple effect: low reimbursements add to the financial strain that leads to service and facility closures, further impacting the availability of affordable, convenient, and quality health care. Please note that not all Medicare Advantage plans are currently accepted at Pawnee Valley Community Hospital, as some reimbursement rates do not align with our standards for providing quality care.
Choosing a Medicare plan requires careful consideration of your health needs and financial circumstances, especially for seniors with fixed incomes and increased health concerns. Remember, your health care providers are here to help and can answer questions, so discuss your Medicare options with them. Information is also available on our hospital’s website pawneevalleyhospital.com/ and Facebook page. You can also visit medicare.gov for more information or call 1-800-MEDICARE to speak with a knowledgeable Medicare representative about coverage options.
