Why Choose Original Medicare with a Supplement Over Medicare Advantage

Over the past five years, our agency has seen a complex mix of clients enrolling in Medicare. Half of our new clients opt for Medicare Supplements in conjunction with Original Medicare, while the other half prefer Medicare Advantage plans.

Freedom and Flexibility with Original Medicare

For the atypical Medicare client who chooses to enroll in a Medicare Supplement with Original Medicare, the primary motivation is often the freedom to select any physician or hospital without undue restrictions. One such client, let's call him John, emphasizes the importance of maintaining control over his healthcare decisions:

‘I have Medicare A because I value the maximum freedom and I don’t want minimum wage billing clerks to override my doctor’s best judgment. Medicare Advantage might be glad they don’t have me in their capitated system because I will likely have over a million dollars in medical bills in 2024.’

The Value of Original Medicare with a Supplement

John has been using Original Medicare Parts A, B, and D along with a Medicare Supplement (Medigap) policy for 13 years. He has chosen this approach for several compelling reasons:

1. Unrestricted Doctor and Hospital Choice

One of the most significant advantages of this combination is the freedom to see any doctor or seek treatment at any hospital across the United States. This is particularly important for individuals who may need specialized care or those living in areas with limited healthcare options.

2. Absolute Out-of-Pocket Caps

Original Medicare with a Medigap policy provides a fixed cap on out-of-pocket expenses. John has had multiple years where his medical expenses exceeded $700,000, and he only incurred around $2,500 in out-of-pocket costs. In most years, his out-of-pocket expenses are even lower, typically under $500.

3. No Pre-approval or Geographical Restrictions

No pre-approval is required for medical tests or procedures, and there are no geographical limitations on where he can receive care. This means John can receive the care he needs, when he needs it, without unnecessary barriers.

4. High-Quality Support

John uses the Federal Employees Group plan instead of Medicare Part B and has had experience with Health Maintenance Organizations (HMOs). He appreciates that with Original Medicare and a supplement, he is not subject to the control of insurance company–hired doctors, which can sometimes detract from the quality of care provided.

The Drawbacks of Medicare Advantage

While Medicare Advantage plans may seem attractive during one’s relatively healthy years, the restrictive nature of these plans can be burdensome when dealing with complex health issues. Here are the primary limitations John and others have encountered with Medicare Advantage:

1. Limited Doctor and Hospital Choices

Many Medicare Advantage plans limit the choice of providers to a network of contracted physicians and hospitals. This can be limiting for individuals with specific preferences or those in rural areas.

2. Referrals Required for Specialists

Specialist visits in Medicare Advantage plans often require referrals, which can be cumbersome and inhibit timely access to necessary care.

3. Pre-Approval for Certain Tests and Procedures

Many Medicare Advantage plans require pre-approval for certain medical tests and procedures, which can delay the treatment process and cause unnecessary stress for patients.

4. Geographical and Coverage Limitations

By nature, Medicare Advantage has geographical limitations, which means it may not cover the entire country. This can be problematic for individuals who travel frequently or live in remote areas.

5. Variable Annual Coverage

The terms and conditions of Medicare Advantage plans can change annually, leading to uncertainty and potential surprises for policyholders.

Conclusion and Future Plans

John's decision to stick with Original Medicare and a Medicare Supplement is based on a clear assessment of the pros and cons of both systems. He advises his parents and in-laws, who also have Medicare and supplements, to make the same choice. As a result, John works for a Medicare agency, which is ironic given his preference for the traditional system.

In conclusion, the flexibility, convenience, and predictable costs of Original Medicare with a supplement makes it a compelling option for individuals who prioritize their healthcare choices and require a high level of control over their medical care.