Is Medicare Advantage Plan bad?

5 min. readlast update: 03.31.2024

Are Medicare Advantage Plans bad?

The reputation for Medicare Advantage Plans have not been the most consistent in the past few years. The bad reputations that follows Medicare Advantage plans are due to the unpelasant experiences some clients have gone through while they are enrolled in these plans. However, many other clients attest to great experiences and speak to the savings they yielded due to the perks offered by certain Medicare Advantage plans. 


What is a Medicare Advantage Plan?

This is how I describe a Medicare Advantage plant to my advisees. It is a health insurance plan offered by private insurance companies to cover Medicare eligible healthcare costs. Medicare Advantage plans are similar in design to regular health insurance plans offered by a job or via the marketplace. With an Advantage plan you may have a decutible, copays, out of pocket max, and coinsurance. Although most Medicare Advantage plans do not have a premium per month, most of MAPD plans are $0 a month, some Medicare Advantage plans may have a premium per month. 

Next: Lets go through the Pros and Cons of Medicare Advantage Plans.

Pros Cons
Most plans have $0 premium Most Medicare Advantage plans have dedutible that you need to meet before plans kicks in. The medical deductible is different than the drug deductible
PPO and HMO options with different carriers Some providers may not be in network or may not accept Medicare Advantage plans
Some MAPD plans include Dental and Vision coverage Some MAPD plans may charge you additional premium for Dental and Vision
MAPD plans have druge coverage included so need to have a stand alone prescription drug plan Some medications may not be covered by certain MAPD plans while covered by other plans
No medicare underwriting needed to enroll in Medicare Advantage plan. You can enroll in a Medicare Advantage plan without answering any medical questions. The rate is the same regardless of medical history You can only enroll in MAPD plans during Annual Enrollement Period, Open Enrollment Period, or Medicare Advantage Enrollement Period
Some MAPD plans offer Part B premium giveback. This would lower your Part B social security dues. The giveback will increase your social security check if Part B is deducted from your socal security check Out of Network coverage and out of state coverage may be limited. If you are on an HMO MAPD plan you can not see doctors out of network unless in cases of emergency. 

Should I enroll in a Medicare Advantage Plan?

After considering the pros and cons of Medicare Advantage plans above, you should be able to make a decision by weighing in what features matter most to you. For instance, if you travel frequently or spend your time in two different states throughout the year, then a Medicare Supplement plan or a PPO MAPD would be a better option. Below are reasons why some of our clients have chosen an MAPD plan.

  1. Cost Savings: Medicare Advantage plans often offer lower premiums compared to traditional Medicare along with additional benefits such as dental, vision, and prescription drug coverage. This can make them more financially appealing to clients.
  2.  Comprehensive Coverage: Many Medicare Advantage plans offer comprehensive coverage beyond what is provided by Original Medicare, including coverage for prescription drugs, vision, dental, hearing, and wellness programs. This comprehensive coverage can be attractive to clients seeking more extensive healthcare benefits.
  3. Convenience: Medicare Advantage plans are typically offered through private insurance companies, which may offer more convenient features such as online portals, telemedicine options, and integrated care networks. This can be appealing to clients looking for easier access to healthcare services.
  4. Extra Benefits: Medicare Advantage plans often include extra benefits not covered by Original Medicare, such as fitness memberships, transportation services, and over-the-counter allowances. These additional perks can enhance the overall value proposition for clients.
  5. Prescription Drug Coverage: Many Medicare Advantage plans include prescription drug coverage (Part D), which can be convenient for clients who want to have their medical and prescription drug coverage bundled together in one plan.
  6. Annual Out-of-Pocket Limits: Unlike Original Medicare, Medicare Advantage plans are required to have an annual out-of-pocket limit, providing financial protection for clients in the event of significant healthcare expenses.
  7. Network Flexibility: While some Medicare Advantage plans have networks of healthcare providers, others offer out-of-network coverage options, providing clients with flexibility in choosing their doctors and specialists.

How to choose the best Medicare Advantage Plan?

In order to have the best medical coverage while on Medicare Advantage, you need to make sure you choose a Medicare Advantage Plan that fits your health care needs and meets your financial feasibility. Read the checklist below before you choose a Medicare Advantage Plan.

  1. Make sure the plan covers all your medicartions and have your providers in network.
  2. Check for the deuctible and out of pocket maximum. Make sure that the latter are affordable and within budget.
  3. Compare additional benefits and perks, like Dental and Vision. 
  4. Do NOT WORK with a captive insuarnce Agent. Captive insurance agents work with one company and are incentivized to sell certain plans. You need to work with an independent insurance agent, like Smart Insurance Agents, who broker multiple medicare insurance plans from different carriers. Independent agents can help you compare different plan options to choose from.
  5. Know your options and rights. Centers of Medicare Services and federal governmetn have put rules in place to protect medicare beneficiary from Medicare enrollement fraud or misleading information. You can always disenroll from a Medicare Advantage plan and go back to original Medicare within your first year of enrollement without any medical underwriting.
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