Medicare Advantage vs. Original Medicare: A St. Louis Resident’s Guide to Making the Right Choice

Will you be 65 years old in the near future, or are you soon to be eligible for Medicare? Among the most significant decisions that you will be required to make, the question of whether you should enroll in Original Medicare or a Medicare Advantage plan would be the most important one. Each option varies in terms of coverage, costs, and benefits, and the suitable one is based on your health, budget, and lifestyle.

If you are looking for information on Medicare Advantage in St. Louis, then this guide is made for you. We will explain to you the fundamental differences between the two Medicare options, what the residents of St. Louis have to consider, and how to get the support that you need to decide with confidence.

What Is Original Medicare?

Original Medicare is a traditional government-funded scheme that is operated by two independent entities:

Part A (Hospital Insurance): Limited to inpatient hospital care, skilled nursing facility care, hospice, and home health services to a certain extent.

Part B (Medical Insurance): Mainly preventive care, including the doctor's visit, outpatient care, and medical equipment.

Original Medicare allows patients to visit any doctor or hospital in the country, provided the doctor or hospital is a Medicare provider. On the other hand, it also does not cover most of the prescriptions, dental, vision, or hearing care. Consequently, several people resort to one or more of these add-ons to support them in covering the gaps:

Part D (Prescription Drug Plan): Medigap (Medicare Supplement Insurance), which is intended for co-pays, deductibles, and coinsurance

Is There Any Difference Between Medicare Advantage And Original Medicare?

The Medicare Advantage program (Part C) is a stripped-down version that offers all the benefits of Original Medicare, with a few exceptions, including coverage for areas not provided by the latter. Private insurance companies approved by Medicare sell it. The benefits provided can surpass those offered by Original Medicare; however, beneficiaries may also be required to use only healthcare providers that belong to the network.

One of those extra benefits could be the coverage of prescription drugs (Part D)

• covering of dental, visual, and hearing aids

• exercise programs (like SilverSneakers)

• free rides and over-the-counter allowances

What St. Louis Residents Should Consider

1. Cost Predictability

Most of the time, you will not have to pay anything, or you will have to pay a minimal amount as a premium for Medicare Advantage plans. However, you will be required to contribute a co-pay or coinsurance when using your benefits. With Original Medicare and a Medigap plan, you can end up paying a higher monthly premium. However, you will be rewarded with a lower amount of out-of-pocket expenses when you get medical assistance.

Think about this: Would you like to have a more expensive but predictable health insurance plan or a less expensive plan with variable costs?

2. Health Needs

In case of a chronic disease that may require you to visit the doctor often and undergo some medical tests, you are advised to obtain a Medigap policy along with Original Medicare, as it will give you lower total costs and more flexibility. On the other hand, if you are a healthy person looking for a small quantity of added incentive, such as a dental or gym membership, then it is safe to say that a Medicare Advantage plan will work perfectly for you.

3. Prescription Drug Coverage

The majority of Medicare Advantage plans available in St. Louis include drug coverage. Individuals on Original Medicare must enroll in a separate Part D plan. You should also review the plan's formulary to ensure that your medications are covered and at the most affordable rate.

Get Help Choosing the Right Plan

One wrong Medicare decision will cost you time, money, and aggravation. Thus, the local Medicare experts in the St. Louis community are the first to come to our minds when we think of the assistance that might be needed.

Cooperating with a certified broker who is familiar with the local healthcare environment is the main guarantee that the following things become possible for you:

• Review and compare all the plans available in your area for a specific ZIP code.

• Get an idea of the provider networks and formularies.

• Select the coverage that best suits your prescription needs and doctor visits.

• Stay clear of mistakes and errors that may lead to you being penalized.

• Receive free and unbiased assistance (brokers are paid by insurance companies, not by the clients) 

Final Thoughts

Suppose you try to compare original medicare to Medicare Advantage St Louis. In such a situation, the decision would be influenced by numerous factors, and the outcome would vary for each individual. The choice that you make should reflect your health status, monetary condition, and what you like. If you take the availability of so many St. Louis plans into account, then having a seasoned local partner by your side will save you much trouble. 

Show Me 65 is your go-to source for comprehending Medicare Advancement in St. Louis. By offering customized assistance and access to the leading plans, Show Me 65 empowers you to make informed decisions—without the stress and confusion.