How to Decide Between Medicare and Medicare Advantage When You Turn 65

Each year, millions of Americans turn 65 and face a key decision that will affect their healthcare spending for the rest of their life: Medicare or Medicare Advantage.

Now, at age 66 she has been shocked again—this time by a sudden barrage of ailments: osteoporosis, a deteriorating hand joint, and arthritis in her left toe. As a result, she’s rethinking Medicare insurance, aware she’ll be using it a lot more than she had planned.While her Medicare Advantage plan has been fine so far, she may switch to traditional Medicare plus a supplemental plan to get more freedom of doctors when open enrollment arrives in October.

READ MORE Only 29% of Medicare enrollees re-examine their plans and only 10% switch during annual open enrollment periods, according to KFF research. Switching gets even more complicated for people who want to exit a Medicare Advantage plan and enroll in traditional Medicare plus a supplemental Medigap insurance plan.

Choosing wisely while you are young and healthy matters, said Harold Stankard, head of Fidelity Medicare Services, a unit of the financial services company. “If you’re not sick the savings are real” in Medicare Advantage plans which typically charge no or low premiums, he said. “But know the risks: Affluent people tend to buy a supplement for peace of mind.”

A couple of years later she was diagnosed with cancer and couldn’t get her Medicare Advantage plan insurance to authorize the treatments doctors were recommending. “She was weak from her disease and stressed by the endless calls and denials,” Caughill said. Medicare Advantage plans limit healthcare usage by requiring patients to see certain doctors and get prior approvals from the insurance companies for treatments, medicines and procedures, according to KFF. If patients go to doctors out of a plan’s network, they must pick up most of the costs up to an out-of-pocket cap that could top $10,000 a year.

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