Why is there a difference between Original Medicare and Medicare Advantage?

Based on pervious blogs, Medicare Advantage would significantly help the United States with its debt. It would also help seniors by providing a cost effective way for them to get medical services without bankrupting them. Let’s face, as we age, medical stuff happens. It goes with the territory. If you look at Original Medicare and ask why that wouldn’t work, it’s simple. Original Medicare has no max out of pocket on medical expenses. If a senior has multiple hospitalizations in a year, they are responsible for 20% of the entire cost after Medicare reduces the bill. There are minor exceptions but not worth discussing at this time.

Medicare Advantage has maximums out of pocket based on whether the plan is an HMO or PPO. The HMO and PPO maximums are $2500-$6700 per year. After a senior reaches that amount, the plan pays 100% of the bills until the New Year. Then it starts over again. The ACA law also has maximums but Original Medicare does not. Doesn’t seem fair, does it?

Len Barend


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