Pros and Cons of Medicare Advantage

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Pros and Cons of Choosing a Medicare Advantage Plan

First off, in all types of Medicare Advantage Plans, you’re always covered for emergency and urgent care. Medicare Advantage Plans must cover all of the services that Original Medicare covers except hospice care and some care in qualifying clinical research studies. Original Medicare covers hospice care and some costs for clinical research studies, even if you’re in a Medicare Advantage Plan.

Advantages: 

Extra Coverage: Medicare Advantage Plans may offer extra coverage, like vision, hearing, dental, and other health and wellness programs. Most but not all include Medicare prescription drug coverage (Part D). In addition to your Part B premium, you might pay a monthly premium for the Medicare Advantage Plan.

Pay as you go: Medicare Advantage is often seen as a pay-as-you-go type of plan. Many of them have little or no premium, aside from the Medicare Part B premium that you must continue to pay. Therefore, on a monthly basis, you could save money on a monthly basis compared with a Medicare Supplement Insurance Plans. If a doctor is only occasionally seen, then a co-pay would be required, depending on the service or treatment you use in that visit. A person who does not see many doctors and may not use medical providers very often, may possibly save money per month by having a Medicare Advantage plan.

Card Consolidation: Medicare Advantage is typically considered an all-in-one program. One card will take care of medical, hospital, and prescription drug benefits. This means that all benefits are paid by showing this one card, rather than having three separate cards for Medicare, a Supplement, and a Part D program.

Disadvantages:

Access to plans: Medicare Advantage plans are registered by county. Plans can vary a lot between two counties, and unlike Medicare Supplement Insurance Plans, every Medicare Advantage plan is somewhat different from one another, even within the same county.

Benefit changes: Medicare Advantage plans change their benefits and coverage each January 1. Even if you stay in your same plan from one year to the next, it is important you read your annual notice of changes, to see if the plan you are in will meet your needs for the upcoming year. If you have doubts or concerns, it is always advisable you contact either that plan’s representative or a knowledgeable insurance advisor to help determine if that plan will continue to be appropriate for you.

Out of Pocket Costs: You are responsible for the co-pays and co-insurance associated with the Medicare Advantage plan you choose. A person who needs to see multiple doctors, or have many tests, treatments, or hospitalizations in one year might find their costs unexpectedly higher than normal because of their plan’s cost-sharing.

Prescription Drug Benefits: Some, but not all Advantage plans require you take their drug coverage, or lack thereof. It is important you make sure the drugs you need are covered by the plan and at as low a cost as they can be. If the plan you are considering requires you take their drug coverage, ensure every drug you take is covered to avoid having to pay its full cost.

The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact your plan. 

Limitations, copayments, and restrictions may apply.

Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year.

You must continue to pay your Medicare Part B premium.

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