Pros and Cons of Medicare Advantage

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, 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.

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

Medicare Advantage Pros

Medicare Advantage often provides additional benefits

Even though MA plans need to offer the same benefits as Original Medicare, they usually add some hearing, vision, prescription drugs and even acupuncture.

Medicare Advantage may cost an additional $0

Even though these plans still require you to pay for your Part B deductible of $257, 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 $9,350

If it so happens that you reach your out of pocket maximum, 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 without a Medicare Advantage plan.

Medicare Advantage offers highly coordinated medical care

MA plans usually provides a structure which your Medical benefits are coordinate through a primary care provider. The concept is that the doctors you visit should be in communication with each other to provide the most effective medical care.

Medicare Advantage Cons

Medicare Advantage has a smaller network

Original Medicare offers the largest nationwide doctor network in the United States.  You can go to any doctor or facility that accepts Medicare.  Many MA plans have more restricted regional doctor networks. This means 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.  Those who want access to Medicare’s larger network but protect themselves from out-of-pocket cost should consider Medigap.

Medicare Advantage may require referrals

Many Medicare Advantage plans a doctor’s referral to see a particular specialist or to go through certain procedures.  This is especially true 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 comparing benefits, doctor networks and copays is 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 $9,350. 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 $9,350 a year).  The biggest complant from our clients about Medicare Advantage is its smaller network and needing referals to see specialist.  Those who do want a larger network of doctors should check out Medigap Pros and Cons. 

If you are still not sure about Medicare Advantage, there are 3 hints that Medicare Advantage is right for you.

This is definitely a lot to take in.  Your next step is to see which MA plans are available in your area and how much they cost. Then give us a call at 800-930-7956 and we can help you understand your options and enroll over the phone. There is no cost for our services.  

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 a larger doctor network and usually less out-of-pocket cost, you should consider Medigap. Get at Medigap Quote here

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 , to see if that is something you are interested in.

For further questions call 800-930-7956.