Medicare Advantage Plans aren’t for everyone. They do, however, have distinct advantages and disadvantages. Here are a few:
Convenient coverage options
With a Medicare Advantage plan, all your coverage options are in one convenient plan. This list includes Medical, prescription drug coverage and extra benefits like dental, vision and hearing coverage.
Personalized plan structures
Medicare Advantage Plans have different plans based on individual needs. There are plans for those with chronic medical conditions and plans for those with low income.
Cost-saving opportunities
Many Advantage plans have no premiums and offer low or no deductibles. And most plans set limits on the maximum out-of-pocket costs you’ll pay during a plan year.
Coordinated medical care
This ensures you have a healthcare team and helps avoid unnecessary expenses and issues like medication interactions. In one study by Trusted Source, researchers found that coordinated care was associated with higher patient ratings and more positive medical staff experiences.
While most people are satisfied with their Medicare Advantage coverage, these plans may also have some disadvantages compared to original Medicare.
Limited-service providers
If you choose an HMO plan, you may be limited in the providers you can see. You will usually face higher fees if you choose to see an out-of-network provider with these plans. Other plan types do give you more provider freedom, though those plans may have higher premiums and fees like copays and deductibles.
Prior authorization requirements
While traditional Medicare almost never requires prior authorization for services, Medicare Advantage plans tend to add this requirement for procedures.
Possible denials of service
A 2022 report from the US Department of Health and Human Services Office of Inspector General (OIG) found that many Medicare Advantage plans denied necessary medical services to seniors that are covered by Medicare rules.
Complex plan offerings
For some people, all the Medicare Advantage Plan options can feel overwhelming.
Additional costs for coverage
Medicare Advantage plans often consolidate costs from original Medicare, but you may notice additional fees. For example, many Medicare Advantage plans include drug deductibles and specialist visit copays.
State-specific coverage
Original Medicare offers the same coverage across the United States. However, Medicare Advantage plans may only offer specific coverage in specific service areas. This means that if you move to a new service area, your current Medicare Advantage plan may be unavailable.
The takeaway
Adapted from an article by Healthline.com
This article is for information only and should not be considered a recommendation. Talk with a licensed Health Insurance Professional about your specific circumstances. For more information you can go to The Texas Department of Insurance.
