Like most everything in life there are both pros and cons to Medicare Advantage (also known as Medicare Part C or “MA” for short).
Finding the right Medicare insurance can be rather confusing for seniors, specially when parsing through the 150-page “Medicare and You” booklet that the government sends out as you approach age 65. We have made a list of the advantages and disadvantages of choosing a MA plan that should help you understand if this product is right for you.
Not included below but also worth mentioning is the fact that Medicare Advantage plans cover the COVID-19 vaccine.
What is Medicare Advantage?
Let’s start with the basics. Medicare Advantage is the name of a group of insurance plans offered by private companies that “replace” Original Medicare.
This means that if you go with Medicare Advantage, all the services traditionally covered by Medicare Part A and B will now be covered under your MA plan (except for hospice care, still covered by Original Medicare). MA benefits may be slightly different than those offered under Original Medicare, but they must offer equivalent benefits by law.
If you are new to MA and want to learn more about how it works, check out our Medicare Advantage Overview page.
Below is a quick overview of Medicare Advantage Pros and Cons. If you scroll further, you will find a more comprehensive explanation of each factor.
Medicare Advantage Pros and Cons
|MA Plan Pros||MA Plan Cons|
|Out-of-pocket maximum is as high as $7,550 a year||Can only switch during Open Enrollment|
|Many plans cost $0 a month||Plans are difficult to compare since no two MA plans are alike|
|Usually includes drug coverage||Usually no nationwide coverage|
|Many include hearing and dental||Mainly HMO plans that require referrals to see specialist|
|Can include gym discounts||Plan can change drug and medical coverage each year|
Medicare Advantage Pros
Medicare Advantage often provides additional benefits
Medicare Advantage may cost an additional $0
Even though these plans still require you to pay for your Part B deductible of $203, you can often get a zero premium policy, which means you will not have to pay anything else for the additional benefits outlined above.
Medicare Advantage has a maximum out-of-pocket cap of $7,550
If it so happens that you reach that amount, you will not have to pay anything else for covered medical services for the remainder of the year. Original Medicare does not offer this maximum, so your expenses can potentially be much higher.
Medicare Advantage offers highly coordinated medical care
MA provides a structure in which coordination is in order. Every provider you visit should be in communication with each other to provide effective medical care.
Medicare Advantage Cons
Medicare Advantage has a smaller network
If you settle for Original Medicare, you get nationwide coverage and can go to any doctor or facility that accepts Medicare. MA is somewhat more restricted and usually works with regional networks, meaning that if you go out of network you may not be covered or the amount of pay will not be taken into account for your annual cap. Be sure to check your plan’s directory to see if your favorite hospitals or doctors are included.
Medicare Advantage may require referrals
Depending on which plan you choose, it is common to need a doctor’s referral to see a particular specialist or to go through certain procedures, specially if your plan is an HMO.
Medicare Advantage plans are not standardized
Unlike Medigap, MA plans are not all the same when it comes to coverage. As we hinted above, some plans may have more benefits than others, so finding the best one in your area at a low comparable cost might be challenging.
Medicare Advantage can change its benefits every year
Every September you should check the Annual Notice of Change that your plan sends you. Changes in premium, network, deductibles, copays and coinsurance are not uncommon. The good news is that if you do not like your plan’s coverage anymore, or you feel that you could get a better one, you can switch your Medicare Advantage plan during Open Enrollment.
Bottom Line for Medicare Advantage
It is very affordable, usually includes Rx coverage and caps your total annual risk to as high as $7,550. Just know that you will be limited to a smaller network and you will still usually have to pay deductible and copay fees that can add up (but not past the max $7,550 a year).
If you are still not sure, there are 3 hints that let you know Medicare Advantage is right for you.
This is definitely a lot to take, Medicare Advantage can be great in many aspects, but it also has its flaws. Considering everyone of these factors is very difficult and time consuming. Remember that we at Senior65.com can do that for you at literally no additional cost. We do not charge anything for our services.
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Other Options for Medicare Enrollees
Most people consider the following 3 options below when researching their senior health coverage.
- Original Medicare
- Medicare Advantage
- Original Medicare + Medigap
Since Medicare Advantage has an out-of-pocket maximum, offers equivalent benefits to Medicare, and often includes drug coverage, MA usually provides more protection than Original Medicare. If you want more medical fee coverage, you should consider Medigap.
Medigap works very differently than MA. Medicare Supplement plans complement Original Medicare and can cover all Original Medicare’s deductibles, copays, coinsurance, and still offer additional coverage. Make sure you check out our Medigap Overview page or read Medigap Pros and Cons, to see if that is something you are interested in.
For further questions call 800-930-7956.
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