The Difference Between Medicare and Medicare Advantage

The good news for seniors today is that there are more Medicare options than ever before! In addition to Original Medicare, there are many different Medicare Advantage plans to choose from. But what's the difference between Medicare and Medicare Advantage plans?
Keep watching as we discuss everything you need to know about Original Medicare vs. Medicare Advantage plans.
Start (0:00)
How does Original Medicare work? (0:58)
Your costs with Original Medicare (2:56)
Who is a good fit for Original Medicare? (3:29)
How does Medicare Advantage work? (4:54)
Most common types of Medicare Advantage plans (6:02)
Your costs with Medicare Advantage (7:28)
Maximum out-of-pocket limit (9:31)
Is Original Medicare or Medicare Advantage right for you? (10:33)
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[@everetteborr]

Thank you for an extraordinary explanation of Original Medicare and Medicare Advantage. Are there penalties for switching between (1) Original Medicare plus Medigap and (2) Medicare Advantage? If you move, I can see where a change may be necessary.

[@daniellekunkle529]

no penalties, but if you leave a MA plan after you have been on it for 12 months or more to return to Original Medicare, then you have to apply for the Medigap plan and answer health questions in most states. Your acceptance is not guaranteed at that point.

[@everetteborr]

@@daniellekunkle529 Thank you, that is a big consideration!

[@BoomerBenefits]

@@everetteborr You're most welcome!

[@S.Tagore]

Why it is so complicated? Cannot the US Govt consider all her citizens equally regarding health care, which must be a basic right for every human all over the world. How much budget is required for that? Cannot the Govt cover that expenses for humanity from the tax earned from such a huge economy of USA? We are now older and it is difficult to remember and also it is difficult to go to the challenges of medical system made so complicated. Please make some necessary changes to be kind towards the senior people. Cannot the Govt get rid of health insurance system and become a welfare state like there in some other countries?

[@sirjuliusnorris7513]

The U.S. Corporate system has to much GREED to allow very much help for the elderly, sadly. Pisses me off knowing my life will be cut short because I can't afford the greed of health insurance companies!

[@BoomerBenefits]

We hear you and completely understand! Thank you for sharing your thoughts!

[@Gheorghe99]

Great presentation, although you omitted to mention that Medicare Advantage is a for-profit enterprise while Original Medicare is not. And to make huge profits, Medicare Advantage has to deny service and decline claims hoping you will die before you exhaust all appeals. In healthcare, time is of the essence, and delaying treatment and surgeries can be costly in terms of life and well-being.

[@BoomerBenefits]

Hi there - thank you for your feedback! Medicare Advantage is sometimes the most cost effective option for some.

[@kelseymundfrom6088]

The clearest and most concise explanation!

[@BoomerBenefits]

Thank you for the kind words, Kelsey!

[@coreyparker9984]

So helpful. Thanks for sharing

[@BoomerBenefits]

You're welcome! We're happy to hear it was helpful!

[@cookingwithcuyandotherfuns6238]

Fantastic presentation---thank you SO much!

[@BoomerBenefits]

You're very welcome!

[@robertdorsey9715]

Thank You

[@BoomerBenefits]

You're welcome

[@shelteredsparrow2736]

Thanks for the info

[@BoomerBenefits]

Thanks for watching!

[@RetrieverTrainingAlone]

One disadvantage of Medicare Advantage is it "in-network" which would not work well for folks like us who winter in the lower-48 for 6 months and summer in Alaska for 6-months. One disadvantage of Medigap plans (even Plan G) is there is no coverage for preventive dental cleaning.

[@lucieelizabethannwesson7016]

I have don't have any in network

[@BoomerBenefits]

Yes, many beneficairies who travel frequently, may lean toward a Medigap plan. However, there are some Advantage plans that offer nationwide coverage depending on whether the provider participates in the plan's nationwide network.

[@RetrieverTrainingAlone]

@@BoomerBenefits Yes Good luck finding a provider in a Advantage network while traveling out of state.

[@BoomerBenefits]

@@RetrieverTrainingAlone If you are a Boomer Benefits client, we can help with this. :)

[@yazminmojica4458]

Thank you for your excellent presentation 💯Bendiciones para usted 🙏🏽

[@BoomerBenefits]

You're welcome!

[@chekelitoCIL]

@@BoomerBenefits Do you have Spanish speakers representatives?

[@BoomerBenefits]

@@chekelitoCIL Yes, we do!

[@HT_LBC]

Thank you for the thorough video! Do you have any information on how much is total average cost for Medicare Part B + Part D + Medigap ? compare to total cost of Medicare Advantange? Thanks!!

[@BoomerBenefits]

The cost of a Medigap plan depends on multiple factors, such as your age, gender, zip code, tobacco use, carrier, and more. Part D plans also vary on zip code! Therefore, we would need some information from you first before we can provide you with accurate quotes. If you would like for our team to look at the plans in your area and provide a comparison, please give us a call at 817-249-8600!

[@lynfl9814]

The title is a misnomer; you might call Advantage Plans 'Medicare Advantage Plan;' but, when you go on an Advantage Plan you are no longer on Medicare. You have exited Medicare. If you want to go back to a regular Medicare Plan; it may be very difficult. To do that you have to pass the 'Medical Health Questions.' I love the name they gave this; instead of calling it what it is. The questions really are being able to pass 'Pre-existing Health Conditions Questions.' Today, most people 65+ have some type of pre-existing condition. You will be denied returning to regular Medicare if you can't pass those Healthcare Questions. This will keep you stuck in an Advantage Plan the rest of your life. You better not have a major health problem on an Advantage Plan; such as, heart issues, heart attack, stroke, diabetes, other auto-immune diseases, cancer. The out of pocket on Advantage Plans may stun you and the healthcare expenses if any of these conditions occur can put people deep in debt and even cause bankruptcy. My best friends sister; got cancer. Her Advantage Plan denied the Chemo treatment she needed for her type of cancer. To get the treatment she needed she put her house up for collateral. When she passed away a year and half later; her home was sold and they got paid. She was stressed before she passed; her and her daughter were very close. Her daughter gave her excellent care over the time she was very ill and her daughter did not get any inheritance. This broke her heart before she passed away.

[@judysuprtrkr3423]

It sounds like she went to MEDICAID THAt yes will take every red cent you have. In fact the day you die ALL ASSETS Are froze your banking everything until they get their money back.

[@lynfl9814]

@@judysuprtrkr3423 No!! She was on an Advantage Plan! I was helping my friend when her sister was going through this horrible situation.

[@BoomerBenefits]

We're so sorry to hear of your friend's sister! We do want to clarify one thing. Original Medicare does not require you to answer health questions. So, you can return to Original Medicare from an Advantage plan with no issues. However, if you wanted to apply for a Medicare Supplement plan, you would likely need to answer health questions and could be denied depending on the situation.

[@mpoharper]

You can’t switch back to Medicare original without approval if you are on advantage. These plans used to be higher rated, but there is now concern that things they should cover legally are being denied.

[@BoomerBenefits]

You do not have to get approval from anyone if you want to switch back to Original Medicare. But, you can only drop your Advantage plan and return to Original Medicare during a qualifed election period, such as the Annual Election Period (October 15 - December 7).

[@mpoharper]

@@BoomerBenefits oh I don’t know where that info came from. You are correct. Mia culpa.

[@pawsjo1713]

​@Boomer Benefits - Medicare Expert but you do for medgap and premiums could be higher then before. Correct?I

[@paulhung2142]

My biggest concern is if you go into a Hospital for a long stay or have to be in a nursing home for awhile does the MA plan or Original Medicare is the better choice.

[@BoomerBenefits]

Original Medicare does not have a maximum out of pocket limit, whereas Medicare Advantage plans do! With that said, Medicare will not cover your stay at a nursing home. If you would like to talk about this with a Medicare expert on our team, give us a call at 817-249-8600.

[@danklein8587]

What is your Commission from Medicare Advantage versus Medicare Part B ? Thank You.

[@daniellekunkle529]

It depends on the size of the agency, and their production and contract with the carrier, but Medicare Advantage plans typically pay only slightly more in year 1. However, once a person has gone through their first year on a Medicare Advantage plan, brokers make only half that in the subsequent years. Medicare put these protections in place to stop the churning of business, so it's good for the consumer

[@davediamond7228]

medi gap plans pay the highest commission

[@c2shiningc176]

How come nobody ever gives us an estimate of the medigap cost on the original medicare plan I live in california 96088 is my zip. I am planning the red white and blue original medicare a, b, and gap coverage w/ d. If you pro's don't tell us than the info... is a bit lets say short. No disrespect, I know who you are and I know your one of the best at what you do. Thanks for the videos and keep up the exceptional work.

[@BoomerBenefits]

Hi there - A Medigap premium is based on multiple factors, such as your age, gender, tobacco use, zip code, and the carrier you purchased the plan through. So, in order for us to give you an estimate, we would need to gather some information from you first. For example, Plan G might be around $90-$150 for some, and $150-$200 for others! You can give us a call directly at 817-249-8600 and we can provide actual quotes for you!

[@cpoul]

@@BoomerBenefits I see a high deductible G for 65 yo, no tobacco in Connecticut for $55...Is this TGTBT?

[@wanaraz]

The Med Advantage means you use there in house Primary care doctors. If you have something more complicated the Primary care will give you a referral. My Advantage plan is max $2800 a year or less. I had a serious problem and yes you have to get an OK from the Advantage plan but my doctor called and they OKed it on the phone. But once you have a serious problem you cannot go back to Medicare supplement for years apparently. If you are in the clear after a few years you can go back. I don't understand why they do that because Medicare is involved with the payment anyhow. My Advantage plan covers me in the State I am in. If I move I don't think they will have the network in another state.

[@BoomerBenefits]

Hi there, you can drop your Advantage plan during a qualified election period, such as the Annual Election Period (October 15 - December 7). During this time, you can drop your Advantage plan and return to Original Medicare. You can apply for a Medigap plan at any time throughout the year. However, you will likely have to go through medical underwriting. If you cannot pass the health questions, you could be denied a Medigap plan or charged a higher premium due to your pre-existing health conditions. With that said, if you have a Medicare Advantage plan and move outside your service area, this will open up a Special Election Period to apply for a new plan in your new area. Be sure to check out our KZbin video, Can I Move with My Medicare Plan? | Moving with Medicare

[@sososo2445]

So since Medicare pays private insurance companies to manage Medicare Advantage Plans, is that a factor in making the rates for Original Medicare higher?

[@BoomerBenefits]

Not necessarily. Medicare premiums are based on several factors. When you enroll in an Advantage plan, Medicare pays the plan a certain amount per month to take on your medical costs, so it can balance out since you are paying a portion of your costs.

[@carolinagirl220]

Hi, on this video @ 3:45 minutes it says that you don't need a referral to see a specialist. Why are specialist now requiring you to get a referral from your family doctor before they see you. I am original Medicare. Thank you for your videos and your time!.

[@BoomerBenefits]

Hi Joyce - Original Medicare does not require a referral, but you might run into a specialty physician that DOES require you have a referral to see them. We have seen this many times with cardiologist & physical therapy. It is not a Medicare requirement, but the provider.

[@carolinagirl220]

@@BoomerBenefits I'm in Nc and just about all specialists are requiring this now. I hate it! Thank you so much!

[@marcryan5399]

Do you plan to get licensed in New York in the future? Because my first experience with Medicare is a on going Horrible experience. I was not aware Medicare used Sub Contractor's. CNBC used you as a source and found your Video's very accurate. I was wondering if you could do a Video on Form CMS-L564? Because Allegaly 776,200 in 2020 people have been tripped up by delaying Medicare Part B. Benes Act 2.0 (S.3675) is supposed to address the problems of delaying Medicare Part B.

[@daniellekunkle529]

No, but we can refer you to a great agent who can help you with plans in NY. Just contact our office for a referral. The Consolidated Appropriations Act (formerly called BENES) does address the delayed Part B. As of 2023, if someone applies for Part B during the General Enrollment Period, their benefits will begin the first of the next month instead of them having to wait for July 1

[@BoomerBenefits]

Hi Marc - We're glad you found us and we thank you for the video suggestion! In the mean time, we recommend checking out our article, Enrolling in Medicare After Working Past 65, which discusses the CMS-L564 form. Here is the link: boomerbenefits.com/enrolling-in-medicare-after-working-past-65/

[@leedanielson7452]

I see no advantage whatsoever to the advantage Medicare… When I turn 65 I’m going with the original Medicare and the high deductible plan G… this to me definitely sounds like the Way to go…. The advantage plan doesn’t look like it has many advantages lol

[@g0989]

There are essentially two primary disadvantages to Advantage PPO plans. 1. Smaller networks that are usually tied to a geographic territory. 2. Pre-authorization often required for some treatment programs or surgical procedures. The advantages are primarily: 1. Lower premiums than most any Medigap. Sometimes zero premium. 2. "All in one" plan that usually includes prescription drug plan, dental, vision, and hearing benefits. Sometimes other benefits like OTC pharmaceutical allowance, gym membership, transportation, etc. Medicare + plan G + Part D is indeed will get you the best medical coverage, but tradeoff will be the highest monthly premium. Usually worth it, though, if you have or anticipate a lot of ongoing costly medical needs.

[@freshbeanne]

My parents have Medicare + Medigap. My sister has an Advantage Plan. My sister is definitely coming out ahead and my parents are sinking a ton of money each month into premiums and pay out of pocket because they have no Part D coverage. I really disagree with you. Plus my sister gets dental &vision coverage and perks like free gym membership, gift cards for getting preventive care, and $75 of free OTC products quarterly. I hope you read this!

[@leedanielson7452]

@@g0989 Thanks!👍

[@leedanielson7452]

@@freshbeanne Thanks I did read it.. I will turn 65 in December so I’m still pretty new to this and learning every day lol. It was nice of you to comment thanks again!😊

[@smileytow1925]

@@freshbeanne so sorry to hear how expensive it is for your parents, not having a part D I can Imagine that got expensive to have to pay for all their medications. My husband will be 65 in July, so we are deciding what to do now. My husband has a friend that was our office manager that needed heart surgery and his advantage plan kept denying the surgery, even with his two heart docs saying he needed it. He did finally get it but waiting from the week after Thanksgiving 2021 until April of 2022 was almost to much for him. ( no, he’s not healthy, but to late to finally stop smoking like he did, the damage is already done) I am guessing that your sister is still pretty healthy. Revisit this when she gets to be your parents age and needs more done. Then you might be able to compare the two. ( it’s sure been an eye opener for us all the choices and prices! I feel sorry for retirees that think Medicare will be free and cheaper, it will be better then what we have now but most definitely not free.

[@57bodie]

How fast do rates rise between MediGap companies vs Medicare Advantage companies? It looks like most MediGap providers are using Attained Age for pricing so costs will go up with age. The Advantage providers seem to use Community Rate like pricing where everyone pays the same price (not age based). Which premiums will rise faster as we age? Will age based pricing cost more over time since age increases are built in? Advantage plans don't seem mention Attained Age, Issue age, or Community Rate pricing. Any historical pricing info on rate increases between MediGap vs Advantage over time?

[@BoomerBenefits]

Hi there! You will want to keep in mind that rate increases on Medigap plans are inevitable. So regardless of community rate, issue age, or attained age, you will still likely receive a rate increase. With that said, it will depend upon your zip code on which Medigap plans will be available to you. Your zip code may only have community-rated plans, or may not offer any. Medicare Advantage plans premiums are not community-rated, attained-age, or issue-aged. Medicare Advantage plan carriers will set their premiums and base it on zip code. Therefore, everyone that has access to a specific plan will have the same plan. Whenever you work with our Boomer Benefits team, one of the things we look at and compare is a Medigap plan's average rate increase. Here on our social media team, we cannot tell you for certain what type of plans you have in your zip code and what their rate increase histories are like. If you'd like, you can give us a call at 817-249-8600 and we can investigate this for you!

[@57bodie]

Do you handle both MediGap and Medicare Advantage plans?

[@BoomerBenefits]

@@57bodie Yes! We also sell Part D plans, dental, vision, and hearing plans, cancer plans, and final expense.

[@susymay7831]

If Medicare denies something, day a blood test, will I pay a lower than cash rate on that bill because Medicare has a lower negotiated rate?

[@BoomerBenefits]

Hi Susy - If Medicare denies a service and you don't have any other form of insurance, then you would likely pay the full price for the service. However, we recommend asking this question to your doctor's office and see if they offer any cash discounts.

[@dmana3172]

I got United Health Care plan since I have medicare and medicaid and I gets $205 a month of credits to get free groceries and that is great. Do you think it's a good plan?

[@BoomerBenefits]

It sounds like it has great added benefits! It's important to ensure your doctors are in-network with your plan and the plan covers your medications. We also recommend viewing the plan's Summary of Benefits document so you know exactly how much you'll pay for each service. As long as you're satisfied with the coverage and your cost-sharing, then it you should be all set! You can also change your Advantage plan each year if anything changes.

[@lucieelizabethannwesson7016]

Don't use a HMO use a PP0

[@BoomerBenefits]

HMO plans can work great for some people, but PPO plans do provide a wider range of providers!

[@davediamond7228]

once you get used to the hmo system ,it isn't bad...and companies like anthem or BlueShield has a large network if you live in and around an urban area

[@lucieelizabethannwesson7016]

@@davediamond7228 HMO means hurry me out

[@rayh2808]

I have Traditional Medicare from age 65, with a Plan F Medigap from BCBS. $183 per month. No co-pays, no coinsurance, no deductibles. Visits to physician and specialists are free. No pre-approval ever required. Part A and Part B deductible are fully covered, also Part B excess charges. Skilled nursing facility covered too. Even Foreign Travel emergency (80%) We can use our Traditional Medicare anywhere in US, no restricted provider networks . One payment for the Medigap Plan F, plus we have a part D plan. $13.00 month. Have never had a single bill from a provider or hospital since we joined Traditional Medicare + Medigap Plan F. With plans like this available, why would one want a Medicare Advantage plan? I know up front what my Medical expenses will be, no delays for critical surgery say, waiting for pre-approval from an insurance company.

[@BoomerBenefits]

Hi Ray, we're happy to hear you are enjoying your Medigap plan! Everyone's healthcare needs and budget are different! Not everyone can afford a Medigap Plan F, and many find Medicare Advantage plans to be intriguing with their low premiums. Some Advantage plan premiums are as low as $0 per month. Medicare Advantage plans can also offer perks, such as dental, vision, and hearing benefits. Also, those who do not visit the doctor often and are relatively healthy often go the Advantage plan route to save money on premiums. Check out our KZbin video, Pros and Cons of Medicare Advantage Plans According to Our Clients

[@pawsjo1713]

That's on top of the monthly fee for medicare original correct

[@lancerx1001]

Medicare Disadvantage

[@BoomerBenefits]

Thanks for your feedback!

[@The_Temple]

Sadly, if you’re under 65 and eligible for Medicare due to disability (SSDI), depending on where you live, supplement plans may not be an option

[@BoomerBenefits]

Yes, you're correct! Be sure to check out our video titled, Medicare for People Under 65 | What You Should Know

[@Colt-ii4qn]

When you get older the last thing you need to worry about being in medical bankruptcy 😮 Max out of pocket should ever be more than 2000.00 per yr but that’s dream world. They want you to die broke

[@BoomerBenefits]

We hear you! This is why many seniors purchase a Medigap plan instead of a Medicare Advantage plan, so they have predictable healthcare costs for the year. Check out our video titled, Medicare Advantage vs Medicare Supplement | How to Choose the Best Medicare Plan

[@sirjuliusnorris7513]

I'm 72 and get a little more than $1,000/mo in SS to live on, so if I apply for either plan, it looks like I'll be joining the growing ranks of the homeless! Grr

[@believer7733]

You and I both! How are we able to afford $350 a month for Medicare? SMH!

[@BoomerBenefits]

We run across many people in a similar state of finances, so those folks usually opt for a $0 premium Medicare Advantage plan. We try to find them a plan that has a low Maximum Out of Pocket to protect them.

[@davediamond7228]

you can probably qualify for state medicade with that small of income..

[@lucieelizabethannwesson7016]

Oh bull. SHARE AN APARTMENT