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 - especially 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.
This article was updated on 6/4/15
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.* MA benefits may be slightly differently 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. Everyone else, check out our Pros and Cons list below.
*Everything except for hospice care -that is still covered by Original Medicare.
Medicare Advantage Pros and Cons
|MA Plan Pros||MA Plan Cons|
|Out-of-pocket maximum is $6700 a year||Still requires you to pay copays and coinsurance fees|
|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|
|Can switch to another MA plan during open enrollment||Hard to switch to plans like Medigap|
Bottom Line for Medicare Advantage
It’s very affordable, usually includes Rx coverage and caps your total annual risk at $6,700. 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 $6,700 a year).
Other Options for Medicare Enrollees
Most people consider the following 3 options below when researching their senior health coverage.
1) Original Medicare
2) Medicare Advantage
3) 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 will want to consider Medigap.
Medigap works very differently than MA. Medigap 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.