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Pros & Cons of Medicare Advantage

MEDICARE HEALTH PLANS

Medicare Advantage plans have become a popular alternative to traditional Medicare of the past decade. There have been millions of seniors opt to receive the enhanced benefits that a Medicare Advantage plan offers versus the basic benefits that Traditional Medicare offers. But is a Medicare Advantage plan the best choice for everyone and what are the disadvantages of selecting a Medicare Advantage plan.

In this post today I want to address both the advantages and disadvantages so that you can make an informed decision when it comes to choosing the plan that best fits your needs. It is very important that you make the right decision especially if you are turning 65 and just qualifying for Medicare because it is in your initial enrollment period that you are afforded the ability to choose a plan without evidence of insurability and it is essential that you make the right decision.

So first let’s discuss the advantages of having a Medicare Advantage Plan.

1-Medicare Advantage Cost​

MEDICARE HEALTH PLANS

It is no secret that with traditional Medicare, there is a Hospital Deductible with Medicare Part A and a 20% uncapped Co-Insurance responsibility for outpatient benefits. Though not required this presents the need for a Medicare Supplement Plan that typically costs in excess of $100 per month for a plan that covers most of the gaps in Medicare. In addition, there is an additional premium required for Part D(prescription drug benefits) plans, not to mention the Medicare Part B premium that is already being taken from your Social Security. These costs can be quite prohibitive for many seniors especially since the majority of Medicare recipients are living on a fixed income.

So one of the first reasons why so many consider a Medicare Advantage plan is the low premiums. In fact, in most areas of the country, you could access a Medicare Advantage plan that has little or no premium whatsoever. Better yet in many areas in the United States where there is a high concentration of people over the age of 65, there are plans that offer a refund of some if not all of your Part B premium. For instance, there are many Medicare Advantage Plans in Florida that offer this benefit.

2-Additional Medical Care Benefits

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In addition to the low costs associated with a Medicare Advantage Plan, there are many additional benefits offered that Traditional Medicare does not offer. Some of those benefits are listed below.

  • Many plans offer Prescription Drug Benefits that are built into the plan with no additional premium. These plans are called MAPD plans and are the most popular choice amongst Medicare Recipients.
  • Dental & Vision Insurance is offered with most plans even though these benefits are limited they offer basic coverage that is not offered by traditional Medicare. For a more compressive Dental & Vision Insurance plan visit our Senior Dental page to request more information.
  • It is not uncommon to find plans that offer rides to and from your doctor this is a real need especially among low-income or disabled Medicare beneficiaries.
  • Over the Counter drugs, many plans offer over the counter drug benefits as well as money for vitamins, bandages, and other medical items. This benefit can be as much as $100 or more quarterly.
  • Coverage for uncommon medical procedures like Acupuncture. This could be a lifesaver for someone suffering from chronic pain and is a benefit that is offered by most Medicare Advantage programs

3-Maximum Out of Pocket Costs

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This benefit is one of the most important benefits offered by a Medicare Advantage plan. There is a maximum out of pocket cost associated with every plan this is typically from $3400 per year and up depending on the plan benefits.

What are the disadvantages of having a Medicare Advantage Plan?

But with all of these great benefits that are offered with a Medicare Advantage plan, there are some disadvantages as well. These typically are situational and do not apply to everyone but if you fall into one of these categories you may want to consider a different alternative.

This benefit is one of the most important benefits offered by a Medicare Advantage plan. There is a maximum out of pocket cost associated with every plan this is typically from $3400 per year and up depending on the plan benefits.

What are the disadvantages of having a Medicare Advantage Plan?

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4-Limited Networks of Doctors

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With most Medicare Advantage plans there is a network of doctors that you are required to see and with a Medicare HMO especially you are restricted to using a doctor contracted with the plan for everything except emergencies.

This is more of a problem for those that live in a more rural area. They may have to travel a distance to find a primary care doctor or specialist that is in-network.

5-Referrals Needed for Non-Emergency Procedures & Specialist Visits

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With most Medicare Advantage plans there is an approval protocol to receiving Non-Emergency Medical Care. This includes things like MRIs, CT Scans, Outpatient Surgery, Minor In-Office procedures, etc…

This is usually a pretty seamless process but depending on the plan could be troublesome as well. Most plans rely on your Primary Care doctor’s recommendation and it is usually not a problem to get a referral.

6-Medicare Advantage plans have Limited Service Areas

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Most Medicare Advantage plans have regional (rather than nationwide) networks of participating providers. To join the plan, you must live in the Medicare Advantage plan’s service area at least 6 months of the year.

MEDICARE HEALTH PLANS

he bottom line is that Medicare Advantage plans may be great for some but not so great for others. If you are comfortable with the plan rules and protocols then a Medicare Advantage Plan may be right for you.

Give one of our Trained Specialists a call and we will be happy to answer any additional questions you may have. Call +1-888-441-7891