Over half of all Medicare beneficiaries are enrolled in Medicare Advantage Plans. These plans often provide more benefits than Original Medicare, yet also have some drawbacks. If you’re approaching Medicare eligibility, it’s important to understand the pros and cons of Medicare Advantage compared to traditional Medicare. This will help you choose the best Medicare option for your needs.
In this comprehensive guide, we’ll cover:
- Medicare Advantage Plan basics
- Pros of Medicare Advantage
- Cons of Medicare Advantage
- How to decide: Medicare Advantage vs. Original Medicare
Let’s dive in to help inform your Medicare decisions.
What is Medicare Advantage?
First, a quick refresher. Medicare Advantage Plans are offered by private insurers as an alternative to Original Medicare. Plans contract with Medicare to provide Part A and Part B coverage. Most plans also include prescription drug coverage.
Some key Medicare Advantage features:
- Offered by private insurers like Blue Cross Blue Shield
- Bundle Medicare Part A, Part B, and usually Part D
- Often have $0 premiums, but have copays and deductibles
- Restrict provider choice to network doctors and facilities
Over 26 million Medicare beneficiaries are enrolled in Medicare Advantage Plans. That’s more than half of the Medicare population. Now let’s explore the key upsides and downsides of choosing Medicare Advantage.
Pros of Medicare Advantage Plans
What are the advantages of Medicare Advantage Plans compared to Original Medicare?
More benefits – Most plans include prescription drugs, dental, vision, hearing, and more. Many have $0 premiums with the added benefits.
Out-of-pocket limits – Plans have a yearly limit on your costs for Part A and Part B covered services. Original Medicare does not have an out-of-pocket maximum.
Predictable costs – Copays for services like doctor visits, hospitalization, and drugs vary by plan. But they are predictable compared to Original Medicare’s coinsurance.
Coordinated care – Many Advantage Plans have provider networks, allowing for more coordinated care management.
Additional perks – Some plans offer gym memberships, transportation to doctors, over-the-counter allowances, and other perks.
Cost savings – Advantage Plans may have lower premiums and deductibles than Original Medicare plus Medigap.
Now that we’ve covered why people choose Medicare Advantage, let’s look at some of the potential disadvantages.
Cons of Medicare Advantage Plans
Here are some of the downsides of Medicare Advantage compared to Original Medicare:
Network restrictions – Provider choices are limited to doctors and facilities in-network. With Original Medicare you can see any provider nationwide that accepts Medicare.
Referrals required – Seeing specialists and getting procedures like MRI scans often requires referrals and prior authorizations. Original Medicare doesn’t have these requirements.
Billing complexities – Seeing out-of-network providers results in higher cost sharing or non-coverage. With traditional Medicare, providers handle claim submissions.
Prescription restrictions – Advantage Plans have formularies that may not cover certain prescription medications. Original Medicare covers most FDA-approved drugs.
Travel limitations – Urgent and emergency care coverage outside the plan’s service area can be limited with Advantage Plans. Original Medicare covers you nationwide.
Plan instability – Advantage Plans can reduce benefits, increase cost sharing, and end contracts with providers from year to year.
As you can see, there are good reasons why over half of Medicare enrollees choose Medicare Advantage. But the tradeoffs with provider choice, referrals, medications, and travel should be carefully considered.
Deciding: Medicare Advantage vs Original Medicare
How do you choose between Medicare Advantage and Original Medicare? Answer these key questions:
- Do your providers accept Medicare Advantage? Research to see if your doctors participate in the plan’s network.
- Do you need referrals for specialists? Advantage Plans often require referrals and pre-approvals. With traditional Medicare you can see specialists directly.
- Will the drug plan cover your medications? Make sure your prescription drugs are on the formulary.
- How important is travel coverage? Original Medicare covers you everywhere in the U.S. Medicare Advantage has limitations outside plan areas.
- Are extra benefits worth provider tradeoffs? Consider if added perks like dental outweigh possible provider access issues.
Also compare premiums, deductibles, and max out-of-pocket costs. Speak with a licensed insurance agent or your State Health Insurance Assistance Program (SHIP) for guidance.
Carefully weighing the pros and cons of Medicare Advantage vs traditional Medicare can lead you to the right healthcare option. Evaluate your priorities and consult experts to make an informed Medicare enrollment decision.
We’re Here to Help
You do not have to spend hours reading articles on the internet to get answers to your Medicare questions. Give Scott Sims at Sims Insurance Medicare Plans a Call at (541) 915-0939. You will get the answers you seek in a matter of minutes, with no pressure and no sales pitch. We are truly here to help.
Are people happy with their Medicare Advantage Plans?
Overall, many Medicare Advantage enrollees are satisfied with their Medicare coverage. However, satisfaction levels may vary depending on individual preferences and experiences.
What are some Medicare options?
Can I enroll in a Medicare Advantage Plan?
Yes, you can enroll in a Medicare Advantage Plan if you are eligible for Medicare coverage. Medicare Advantage Plans often offer additional benefits beyond what is provided by traditional Medicare.
Are Medicare Advantage beneficiaries satisfied with their Medicare coverage?
Many Medicare Advantage beneficiaries are satisfied with their Medicare coverage. These plans often provide more comprehensive coverage, including prescription drugs and additional benefits such as dental and vision care.
How can I find a Medicare Plan that suits my needs?
You can use the Medicare Plan Finder tool available on the official Medicare website to compare and find a Medicare Plan that meets your specific coverage requirements.
Are people in Medicare Advantage able to choose their preferred doctor?
Medicare Advantage Plans often have networks of preferred providers. While you may have some flexibility in choosing your doctor within these networks, it is important to check if your preferred doctor is included in the plan’s network before enrolling.
What is the Medicare Open Enrollment period?
The Medicare Open Enrollment period is an annual period when Medicare beneficiaries can make changes to their Medicare coverage. During this time, you can switch from Original Medicare to a Medicare Advantage Plan or vice versa.
How do Medicare Advantage Plans differ from traditional Medicare?
Medicare Advantage Plans are offered by private insurance companies and provide the same benefits as traditional Medicare (Part A and Part B). However, they may also offer additional benefits such as prescription drug coverage, dental, vision, and hearing care.
Do Medicare Advantage Plans cover Medicare Part B?
Yes, Medicare Advantage Plans must cover everything that Original Medicare covers, including Medicare Part B services.
Are people happy with their health insurance plans?
Satisfaction with health insurance plans can vary among individuals. It is important to evaluate your personal needs and preferences when choosing a plan to ensure it meets your specific healthcare needs.