Comparing Original Medicare & Medicare Advantage

Comparing Original Medicare & Medicare Advantage

Ayasha and Heather discuss the differences between Original Medicare and Medicare Advantage and how it effects long-term care residents.
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Transcript

Comparing Original Medicare & Medicare Advantage

Ayasha Thomason

Hi, I’m Ayasha Thomason.

Heather Stallings

And I’m Heather Stallings.

Ayasha Thomason

Today we’re going to talk about the differences between original Medicare and Medicare Advantage plans.

Heather Stallings

So what’s the difference?

Ayasha Thomason

So really think of a Medicare Advantage plan as sort of something that if you were at a restaurant and you had a prefixed menu, you just order what’s for dinner and that’s what they bring you. And then think of the original Medicare plan as the buffet and you can go up and get whatever you want whenever you want. So that’s kind of the difference between the two. So if you go with original Medicare, you get to choose your doctors, your specialists. You’re not limited by any network or anything kind of like you would be with the Advantage plan. The Advantage plans also advertise themselves as being sort of like an elite membership to something. As part of your enrollment in this plan, you get maybe a gym membership or you get a discount at a wellness program or something. It will often include some dental and vision benefits, however, you’re limited to the doctor that you see, all the other specialists and providers that you can see within that certain network. So it really would limit you if you ever got put into a rehab facility or a nursing home as far as providing you. 

Heather Stallings

So that is something that we see in a lot of our facilities. Those that do have these Advantage plans, it does limit them in coming in and doing some of our skilled services, which is very needed and limits the ability to see certain providers and nurse practitioner care is really important in these facilities and the nurse practitioner can’t round on them to see them daily then it can affect their quality of life and their ability to get better.

Ayasha Thomason

You need to educate your loved ones on the different types of insurance plans and policies that are out there. Think about those older adults that like to travel. If you pick a certain Medicare Advantage plan, you’re very limited as geographically as to where you can see a provider. That’s another thing to consider. 

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