Medicare Open Enrollment: October 15th, 2023 – December 7th, 2023
Every year during open enrollment, current Medicare enrollees have the option to:
- Switch from one Medicare Advantage plan to another
- Switch to traditional Medicare coverage
- Switch from traditional Medicare coverage to Medicare Advantage coverage
Know the Difference
Medicare Advantage is not the same as traditional Medicare. There are key differences that may affect how, when and where you get the medical care you may need.
Each Medicare Advantage plan is also different. Comparing each plan’s covered benefits, limits, provider networks, restrictions and cost-sharing requirements can be challenging. It may be difficult to know if a specific plan will meet your needs in the event of injury, illness or disability.
Traditional Medicare vs. Medicare Advantage
If you’d like to print this chart and discuss it with your family and Coryell primary care physician, download it here.
| Traditional Medicare | Medicare Advantage | |
|---|---|---|
| Access to Doctors | Almost all doctors participate in traditional Medicare. You can see any doctor or provider anywhere in the country. | Most Medicare Advantage plans limit the doctors or providers you can see. If your doctor recommends a specialist, he or she may not participate in your plan. |
| Referrals to Specialists | No referrals are required to see a specialist. | Referrals or prior plan approval are almost always required before you can see a specialist. |
| Access to Care When Traveling | Services are covered no matter where you are in the United States. | Coverage is usually limited to doctors and services in the plan’s network and geographic area. |
| Hospital Stay Limits | There are no hospital stay limits. Your doctor decides how long you need to stay in the hospital based on your condition and needs. | Your plan may limit how long you can stay and make decisions about your treatment that differ from what your doctor suggests. |
| Coverage for Lab, X-Ray & Diagnostic Services | You and your doctor decide if you need a diagnostic procedure. | Most Medicare Advantage plans need to approve a request for a diagnostic procedure. Requests for approval may take up to three days. They may be denied based on their determination of necessity instead of your doctor’s. |
| Coverage for Home Health & Medical Equipment | You and your doctor decide if you need home health or medical equipment. | Most Medicare Advantage plans need to pre-approve any request for home health or medical equipment. Requests for approval may take up to three days. They may be denied based on their determination of necessity instead of your doctor’s. |
Frequently Asked Questions
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Q: Isn’t Medicare Advantage a cheaper option for seniors?
A: Not necessarily. It’s true that Medicare Advantage plans have an annual cap on your out-of-pocket costs. However, you may incur unexpected costs if:
- You see a doctor or specialist who is outside of your plan’s network of providers
- You need to travel out of town to see a doctor who is in your plan’s network
- You need care while traveling
- You need to stay in the hospital longer than your plan allows
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Q: Can’t I just switch back to traditional Medicare if my plan isn’t working for me?
A: You can only switch back to traditional Medicare during the federal government’s Medicare open enrollment period. This year, it’s October 15th to December 7th, 2023. The potential risk for enrolling in a Medicare Advantage plan, even temporarily, is that it can make getting supplemental Medigap coverage more difficult and expensive.
Most seniors who choose traditional Medicare will also want Medigap coverage to help pay for out-of-pocket costs. Medigap coverage is most affordable when you first become eligible for Medicare. That’s because the price isn’t dependent on any medical conditions you have, the prescription drugs you use or the number of doctors you see.
If you wait to purchase Medigap coverage until you switch from a Medicare Advantage plan to traditional Medicare, your Medigap coverage will be underwritten (your medical history and pre-existing conditions factor into the cost). Suppose you’ve used your Medicare Advantage plan for medical care. In that case, your Medigap policy will be more expensive than if you opted for traditional Medicare plus Medigap coverage when you first became eligible for Medicare.
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Q: Aren’t Medicare Advantage plans a better deal because they offer more services than traditional Medicare?
A: Many Medicare Advantage plans do offer “perks,” like gym or Silver Sneakers memberships. Some offer benefits not covered by traditional Medicare, such as hearing, vision and dental.
Medicare enrollees need to carefully weigh the value of these perks against the potential out-of-pocket costs for hospital stays, surgeries, medical equipment, X-rays, lab services, ambulance transport and other services.
Medicare Advantage plans do not cover any care you might need when you travel. If you’re visiting family or friends and need medical care, your plan is unlikely to pay for it.
Medicare Advantage plans also do not cover “swing bed services.” You may not think about swing bed services when you’re healthy. Only traditional Medicare will pay for you to stay in the hospital for extra recovery time and receive rehabilitation services after a procedure.
Swing bed services can take place in your local hospital, and you get the care you need to recover successfully. With Medicare Advantage coverage, you’re required to go home once the plan decides you don’t have to be in the hospital.
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