Which Medicare Option is Right for You?

“Toni, thank you for helping us understand the importance of choosing the right Medicare option for my husband, Clint, and me. When he retired a few months ago at age 70, Clint was set on selecting a Medicare Advantage PPO plan because it had a $0 monthly premium. He thought the only difference between a Medicare Supplement and a PPO plan was the cost. Last week, Clint received a diagnosis of terminal lung cancer. If we had chosen the PPO Advantage route, Clint and his medical team would not have had full control over his healthcare. Please share our story with your readers to highlight how quickly healthcare needs can change, just as Clint’s did.” – Raquel

Listen Here:

It’s so important for Americans to recognize the differences between Original Medicare, Medicare Supplements, and Medicare Advantage PPO Plans beyond just the premiums. Let’s break it down:

Original Medicare vs. Medicare Advantage:

• Original Medicare – Offers the flexibility to use any healthcare provider or facility that bills Medicare. The Medicare Supplement you choose covers out-of-pocket costs not paid by Medicare Parts A and B.
• Medicare Advantage PPO Plan – Typically has lower premiums but involves lower costs for in-network providers and higher out-of-pocket expenses for out-of-network services. For 2025 plan details, refer to your new Medicare & You handbook or visit Medicare.gov.

Most people with a Medicare Advantage PPO plan don’t consider the possibility of paying out-of-network providers. As medical options change, many providers or facilities may not be in the network nationwide with an MA PPO plan.

Key Differences:

• Medicare Supplement – Works alongside Original Medicare, covering costs for medically necessary services. You need a separate Medicare Part D prescription drug plan, which should start the same month as your Supplement. Note that premiums can increase annually.
• Medicare Advantage PPO Plan – Requires enrollment in both Medicare Parts A & B and residency in the service area for at least six months a year. The insurance company receives a monthly payment from Medicare for your care under the MAPD plan you’re enrolled in. Use only your Medicare Advantage Plan insurance card for services. These plans cover all Part A and Part B benefits, and some include Part D. Additional benefits like gym memberships, dental, and vision may also be available.

As Raquel and Clint learned, healthcare needs can shift suddenly. Review your options carefully because, with Medicare, what you don’t know can indeed have consequences.

Want to learn about this year’s Medicare AEP changes?

Join Toni’s “Confused about Medicare AEP” Zoom Workshop, which is live, free, and nationwide, on Wednesday, October 23, at 4:00 PM CST. To register, visit www.tonisays.com or call 832-519-8664 for more details.

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