The Good, the Bad, and the Rumors about Medicare Advantage Plans

There’s a lot of confusion surrounding Medicare Advantage plans.

The commercials make them seem like the best thing since sliced bread. Then, there are also horror stories about bad experiences with Medicare Advantage plans.

What’s the truth about Medicare Advantage plans?

In this video, we’ll go through the good, the bad, and the rumors about Medicare Advantage plans so you can make an informed decision about whether this type of Medicare coverage is right for you.

Confused about your Medicare coverage options? Watch our free video: How to Find the Best Medicare Coverage Without Paying More Than You Need To… ​ ​

The Good:

1. Low monthly premiums.
   
   Usually, Medicare Advantage plans have far lower premiums than Medicare Supplement plans. Medicare Advantage plans are paid a set amount by Medicare every month to manage the care of each of their enrollees. Because Medicare is paying toward your care, Medicare Advantage companies often only charge enrollees a very low or even $0 monthly premium.
   
   You do have to keep paying your Medicare Part B premium, which for most people in 2021 is $148.50/month.
   
2. Annual out-of-pocket maximum.
   
   Every Medicare Advantage plan has a cap on how much an enrollee can spend during a calendar year on covered services.
   
   Before you enroll, you’ll be able to see what the absolute worst case financial scenario could be with any Medicare Advantage plan.
   
3. Added benefits.
   
   Medicare Advantage plans often include coverage that isn’t included in Medicare Supplements.
   
4. One complete plan for health and drug coverage.
   
   Instead of having a Medicare Supplement plan for your health coverage plus a Medicare Part D plan for your drug coverage, and a separate policy for your dental and vision care, Medicare Advantage plans that include Part D prescription drug coverage combine total health coverage into one plan.
   
   It can be simpler to manage one plan rather than two or three when seeing providers and tracking premium increases.

The Bad

1. Networks.
   
   Medicare Advantage plans have networks that you have to stay within in order to receive care. Some Medicare Advantage plans have no coverage outside their networks. Others have some coverage out of network, but you will pay more if you choose to use out of network providers.
   
   It is so important to research the plan networks both before you enroll in a Medicare Advantage plan initially, and then every year during the Annual Enrollment Period to know whether your medical providers are in your plan’s network and whether they are remaining in that network for new plan years.
   
2. High costs for high medical service usage.
   
   If you have a year when you have a serious illness or injury and need a lot of medical care, you will pay a copay or coinsurance amount every time you receive medical treatment.
   
   If you have a lot of medical treatment, those copays can really add up. Before enrolling in any Medicare Advantage plan, look through the plan’s Summary of Benefits and Evidence of Coverage documents to see exactly what the costs to you will be if you need surgery, hospitalization, physical therapy, diagnostic tests, or any other likely treatments.
   
3. Plan research is necessary.
   
   Because Medicare Advantage plans can change every year, and because they don’t have standardized coverage like Medicare Supplements, some research is necessary every year to learn how your Medicare Advantage plan is changing and whether it will still be your best coverage option in the new year.
   
   Of course, a Medicare plan broker can assist you with this, but there is still a bit of a time commitment during the Annual Enrollment Period to do your due diligence to make an informed choice.
   
4. Prior Authorization.
   
   This can be a big issue depending on the plan. Again, research is necessary to know which services require prior authorization before you enroll in a plan.
   
   Prior Authorization can delay your medical treatment. There is another video that explains Prior Authorization, which is linked here.
   
5. Financial Risk.
   
   Doing some math before enrolling is necessary. Know the annual out-of-pocket max for plans you are interested in.
   
   Because these are annual limits, it’s important to realize that they reset every year on Jan 1. If you met your out-of-pocket max due to an illness late in a calendar year, you could potentially hit it again early the next year if you have ongoing treatment.
   
   Before enrolling in a Medicare Advantage plan, take an honest look at your finances and determine whether you could withstand a few years of paying the annual maximum.
   
   If the answer is no, a Medicare Advantage plan might not be the best option for you.

Rumors:

1. If you enroll in a Medicare Advantage plan, you won’t have to pay your Medicare Part B premium anymore.
   
   This is false.
   
   To be eligible to enroll in and stay in a Medicare Advantage plan, you have to remain enrolled in Medicare Parts A and B and pay any necessary premiums.
   
   This includes your IRMAA if you have one due to higher income. More on that in the IRMAA videos linked here and here.
   
2. You won’t have coverage if you travel.
   
   There are different types of Medicare Advantage plans. Some plans have regional networks. Others have nationwide networks.
   
   If you travel or spend part of the year in another location, be sure to look at the plan network before enrolling to see if it will cover your travel.
   
3. Medicare Advantage plans cover less than Medicare.
   
   This is false.
   
   By law, Medicare Advantage plans have to cover what Medicare Parts A and B cover. Many Medicare Advantage plans cover more.
   
   There is a different payment structure, but before any plan is allowed to be sold, it must meet or exceed coverage criteria from Medicare.
   
4. Medicare Advantage plans are free.
   
   This is not true.
   
   Even a $0 premium Medicare Advantage plan isn’t free. All Medicare Advantage plans have copays or coinsurance amounts that you are responsible to pay if you receive medical services.
   
5. Medicare Advantage plans are bad.
   
   This is also false.
   
   Medicare Advantage plans are not bad. Neither are Medicare Supplements. There is no one size fits all plan. Different people with different financial and health situations will find the best Medicare coverage for them is going to be different from their spouse’s, or neighbor’s, or sibling’s coverage.
   
   There are lots of options for Medicare coverage. The way to find the best plan for you is to be an educated consumer. Know before enrolling how each plan works and which plan will best fit your unique needs.

If you have Medicare Advantage questions, please feel free to give our office a call at 877-312-1414 or schedule a free, no obligation Medicare Plan Consultation. We’re here to help you become an educated consumer and make the best possible Medicare coverage choice.