Choosing the Right Medicare Coverage: Comparing Plans for Open Enrollment
Choosing the right Medicare coverage is one of the most important decisions you’ll make during Medicare’s Open Enrollment period from October 15 through December 7. At HaysMed, we know navigating the options can feel overwhelming, and we’re here to provide clarity and support so you can make the choice that’s best for you.
What Are My Medicare Options?
Original Medicare is the traditional health plan provided by the federal government and consists of two parts:
- Part A (Hospital Insurance): This part covers inpatient hospital care and nursing facility care, nursing home care, hospice care and home healthcare.
- Part B (Medical Insurance): This part covers physician visits, outpatient care and preventive services. This can also include medical equipment, mental healthcare or ambulance services.
With Original Medicare, you have the flexibility to visit any healthcare provider who accepts Medicare, allowing you to choose your doctors and hospitals. This is the typical Medicare plan most people are familiar with. Additionally, you can enroll in supplemental programs like Medigap, which help cover additional costs, or you can opt for Medicare Part D for prescription drug coverage. The majority of Medicare beneficiaries living in rural areas opt for this Medicare plan, based on coverage and access.
Medicare Advantage (Part C) is an alternative to Original Medicare offered by private insurance companies. It replaces both Part A and Part B, and some plans may also include additional benefits such as vision, dental and fitness programs. However, coverage and provider choice may be limited depending on your local area, so it’s important to know the differences as you make your decision.
A Side-by-Side Comparison of Medicare and Medicare Advantage
| FEATURE | ORIGINAL MEDICARE | MEDICARE ADVANTAGE (PART C) |
| Coverage | Part A (Hospital) + Part B (Medical) | Includes Part A & B, often bundled with prescription drug coverage (Part D) and extras |
| Provider Choice | See any doctor or hospital in the U.S. that accepts Medicare | Must use in-network providers for lowest costs; requires prior authorization |
| Prescription Drugs | Not included (must add a separate Part D plan) | Usually included |
| Additional Benefits | Does not cover extras like vision, dental, or hearing | Often includes extra benefits such as dental, vision, hearing, wellness programs |
| Costs | Standard Part A and Part B premiums, deductibles, coinsurance | Varies by plan and may have lower out-of-pocket costs but limited provider networks |
| Out-of-Pocket Limit | No cap on yearly out-of-pocket costs | Annual out-of-pocket maximum provides financial protection |
| Travel | Nationwide coverage | May be limited outside your plan’s service area |
What to Consider When Choosing
When deciding between Original Medicare or Medicare Advantage, consider the following:
- Your providers: Do you want to continue seeing the same doctors and specialists?
- Your prescriptions: Are your medications covered under the plan you’re considering?
- Your lifestyle: Do you travel frequently and need flexibility, or do you prefer coordinated local care?
- Your budget: Are lower monthly premiums or an out-of-pocket cap most important to you?
There is no one-size-fits-all solution for Medicare. The right plan depends on your health needs, financial situation and personal preferences. Our priority as your partners in health is to provide helpful information to guide you in making the best choice for your needs (or the needs of your loved one, if you are helping someone else choose a plan).
Helpful tip: Before enrolling, check with your insurance provider to confirm that the plan you’re considering is available and accepted in your area. Many providers have changed or discontinued coverage in certain regions. If you are renewing or switching plans, ensure that your selected plan provides local coverage.
Still Undecided?
Making the right choice between Original Medicare and Medicare Advantage can be challenging, but you don’t have to navigate it alone. Contact your healthcare provider or Senior Health Insurance Counseling for Kansas (SHICK) for personalized assistance.
Reminder: Medicare Open Enrollment runs from October 15 through December 7. Take the time to review your coverage and make changes if needed.
Need more help? Call 1-800-MEDICARE for personalized support or visit medicare.gov to compare plan coverage in your area.
