During this time of year, patients are often deciding on their health insurance for the upcoming year. We get lots of questions about the difference between Traditional Medicare and Medicare Advantage plans. Here are some of the differences between the two. The differences in regards to physical and occupational therapy are listed at the bottom.
Choice
Traditional Medicare: Allows you to see any doctor or specialist that accepts Medicare.
Advantage Plan: Typically has a network of preferred providers, limiting your choices.
Network Restrictions
Traditional: Nationwide coverage with no need for referrals to see specialists.
Advantage Plan: May have regional limitations and often requires referrals to see specialists.
Coverage
Traditional: Standardized coverage, making it easier to understand. Coverage remains consistent regardless of where you live.
Advantage Plan: Coverage can vary and plan structures may change annually, impacting benefits and costs.
Prior Authorization
Traditional: Generally, no prior authorization is needed for medical services.
Advantage Plan: Often requires prior authorization for services.
Supplemental Coverage Options
Traditional: You are given the option to purchase supplemental Medigap insurance for added coverage.
Advantage Plan: Limited options for supplemental coverage.
Portability
Traditional: Provides consistent coverage across states and regions. You can be seen anywhere that accepts Medicare within the United States.
Advantage Plan: Coverage may change when moving to a different service area.
Primary Care Physician
Traditional: You are not required to choose a primary care physician.
Advantage Plan: Often requires you to choose a primary care physician. Your PCP will have to send referrals for specialty services.
Cost
Traditional: Your out-of-pocket costs are typically more predictable.
Advantage Plan: Your out-of-pocket costs can vary, and unexpected expenses may arise.
Physical & Occupational Therapy
Traditional: You will not owe a copay for therapy services and prior authorization is not required. Referrals are required.
Advantage Plan: You will most likely owe a copay for therapy services (usually $40-$50 per visit), and prior authorization is usually required. Referrals are required.