I recently received a phone call from a woman who lost her health insurance when her husband passed away. After researching her options online, she called what she thought was Medicare and enrolled in a plan. Later, she discovered that her plan was not Medicare. In fact, she had called a third-party marketing organization that enrolled her in a Medicare Advantage plan, or Medicare Part C. When she realized what had happened, it was too late to enroll in Original Medicare. She was stuck with the Medicare Advantage plan. 

A Medicare Advantage plan, also known as Medicare Part C, is an umbrella term for private health plans approved by Medicare that combine Parts A and B, also known as Original Medicare. Medicare Part A covers hospital stays/inpatient care. Medicare Part B covers doctor visits/outpatient care. And lastly, Medicare Part D is prescription drug coverage.   

For most Medicare beneficiaries, a Medicare Advantage plan is not the best choice. Unlike Original Medicare, Medicare Advantage plans have networks. To receive maximum coverage, beneficiaries are restricted to seeing in-network providers. Contracts are regularly renegotiated, so a doctor or hospital that is in-network one year could be off the plan the following year. While consumers are often drawn in by promises of zero-dollar copays, there are hidden costs and limits on what’s covered.

Original Medicare: The gold standard

Unlike Medicare Advantage, Original Medicare is accepted across the country. It has no networks, no copays, no pre-approvals, no prior authorizations and no maximum out-of-pocket costs. When coupled with a Medicare supplement policy, it provides predictable, affordable healthcare costs.

Unfortunately, the scenario experienced by this caller is not uncommon. Medicare Advantage plans spend millions in marketing each year targeting seniors who are faced with complex decisions about their care. It’s easy to google “Medicare” and find hundreds of results that look official. Because of this, it is essential to read the fine print and be sure you know what you’re signing up for. Be careful what you click on!