How to compare Original Medicare and Medicare Advantage

in /Ask Phil by

David – Nev.: I take one expensive drug and three low-cost generics. I have always had a Medicare supplement plan (Medigap), but I’m considering a Medicare Advantage plan to save money. What do you think?

Phil Moeller: Well, first off, I’m assuming you also must have a stand-alone Part D prescription drug plan, because Medigap doesn’t cover drugs. So I’m guessing your real question is whether an Medicare Advantage plan will cost you the same or less for the drugs you need, while its out-of-pocket annual maximum will give you catastrophic protection for less money than your Medigap plan. Based on your current health care needs, the answer is almost certainly yes — a Medicare Advantage plan with a bundled drug plan will be cheaper.

But you shouldn’t stop there. What would happen if you needed a complex surgical procedure, faced an extended hospital stay or had to start taking one or more really expensive drugs? If you wanted to see the best specialty surgeon in the country for what ails you, for example, would this be covered under your Medicare Advantage plan? Probably not, but you should check before you get the plan. Ditto with having that procedure in a hospital 1,000 miles away that is renowned for the specialty care you need. As for really expensive drugs, both stand-alone Part D plans and bundled Medicare Advantage drug plans have the same catastrophic coverage, and you never have to pay more than 5 percent of the cost of drugs once you reach this stage of any Medicare drug plan.