The Pros and Cons of Getting a Medicare Advantage Plan

If you’re curious about the pros and cons of getting a Medicare Advantage plan, we’ve got you covered. Learn more here now!

Around 90 percent of older Americans are on Medicare or plan to enroll in the program. Yet many retirees say they wish they had a better understanding of the program when they signed up.

You do have to make some choices when you sign up for Medicare. You want to be sure you’re making the right ones. The choices you make now can affect both the coverage you have now and the coverage you’ll have in the future as well.

One of the choices people have to make is about getting a Medicare Advantage plan. There are some perks to getting one of these plans, but many people also see that there are drawbacks.

Does it make sense to enroll in a Medicare Advantage plan? This guide will help you decide by going over both the pros and the cons.

What Is a Medicare Advantage Plan?

The first step in making a good decision about Medicare coverage is understanding the parts of the program.

Original Medicare covers Part A and Part B of the policy. Part A offers you insurance to cover hospital stays and most inpatient services. Part B covers outpatient services, doctor’s visits, and more.

Original Medicare has some gaps in it, which means it doesn’t offer you coverage for everything. Some people will opt to get a Medicare supplement plan, or Medigap plan, to cover these holes.

You can also choose to enroll in Medicare Part C, which is also known as a Medicare Advantage plan. Part C offers you more extensive coverage. Medicare Advantage may go beyond Original Medicare in many ways.

Occasionally, Medicare Advantage plans overlap with Part D of Medicare. Part D is optional, but it provides prescription drug coverage.

Medicare Advantage vsMedigap

Medicare Advantage plans and Medicare supplement plans provide extra coverage. They are not the same thing, though.

Medicare supplement plans fill in the “gaps” of the Original Medicare program. To that end, these plans help cover co-payments, deductibles, and more. Some supplement plans also offer emergency travel insurance.

Medicare Advantage plans combine Parts A and B of Original Medicare with extra coverage. That may include extended benefits for hospital services or hospice care.

Medicare Advantage plans usually have coverage for expenses not offered by Medicare. These might include:

  • Dental care
  • Vision care
  • Hearing care
  • Preventive care
  • Some home healthcare services
  • Prescription drug coverage
  • Fitness memberships

These go over and above what Medicare offers.

How Do Medicare Advantage Plans Work?

To get Medicare Advantage, you’ll enroll in Part C of Medicare. Doing this means you’ll decline coverage for Parts A, B, and D.

You’ll also work with a private insurer. You can shop around to find a provider who offers a plan to suit your needs. Keep in mind that premiums vary between providers and plans.

Not all plans include the same level of coverage. Some plans may have dental care and vision care, while others don’t.

You’ll also need to choose from a few different types. The types usually refer to how fees will be assessed. Types of Medicare Advantage plans include:

  • Health Maintenance Organization (HMO)
  • Preferred Provider Organization (PPO)
  • Private Fee-for-Service (PFFS)
  • Special Needs Plan (SNP)
  • Medical Savings Account (MSA)

If you had coverage through a workplace, you may recognize the HMO and PPO structures.

HMO plans are usually more affordable. They work by providing access to a care network. So long as you receive care within the network, you’ll be covered.

A PPO, by contrast, gives you more flexibility. You don’t need to choose a provider within a network to receive coverage. In-network care and out-of-network care have different fees, though.

PPO plans are usually more expensive. A PFFS plan offers more flexibility, much like the PPO. SNPs focus on helping those with chronic health conditions manage their care.

Finally, the MSA gives you access to both a high-deductible health insurance plan and a savings account. You can use the funds in the MSA to cover the costs of the deductible. The health insurance plan usually has much lower premiums due to the high deductible.

Pros of Getting a Medicare Advantage Plan

Now you understand what a Medicare Advantage plan is, as well as how it works. Your next question is, “Why get a Medicare Advantage plan?”

There are some benefits of getting one of these plans. One of the biggest is that there are cost-savings opportunities. Many plans have no deductibles, and some offer no premiums as well.

Even if you choose a Medical Savings Account, you’ll have funds to help cover the high deductible. That’s much different than Original Medicare.

There are deductibles for both Part A and Part B of Medicare. Unless you get a Medigap plan as well, you’ll need to pay those deductibles out of pocket.

The Medicare Advantage plan can help you save by eliminating those deductibles. Since some Medicare Advantage plans set maximums on how much you can pay out of pocket as well, you could save even more.

Finally, the plan structure you choose could also save you money. If you choose a Medicare HMO plan, for example, you could save even more.

Personalizing and Coordinating Medical Care

Medicare Advantage plans also offer more flexibility than Original Medicare. You have some more choice with Medigap policies, but even they don’t offer the same degree of personalization.

With a Medicare Advantage policy, you get to choose the structure that best suits you. You can also shop around for plans that have better coverage. If you’re concerned about price, you could choose an MSA plan that doesn’t offer dental or vision coverage.

If price is less of a concern, then you might choose a PPO plan that covers everything from dental to vision to your gym membership.

There’s also the benefit of more coordination between the medical professionals you work with. This is a specific feature of certain plans. With coordinated care, healthcare professionals actively communicate with each other about your health.

In turn, you receive better and more personalized care.

Convenient Coverage

Finally, the Medicare Advantage plan offers more convenient coverage. In essence, it puts everything you could get with Medicare and puts it together in one package.

With Original Medicare, you have much more to manage. You’ll need to sign up for Parts A and B. If you want prescription drug coverage, you need to enroll in Part D.

If you want extra coverage, you’ll need to look at one of the supplemental plans. That’s four different plans to manage, and you don’t even have dental care or vision benefits.

Medicare Advantage, by contrast, puts everything together. You only need to worry about one plan then.

Cons of Getting a Medicare Advantage Plan

Medicare Advantage plans have some pretty decent benefits, so why doesn’t everyone have one? There are also some drawbacks to these plans.

The list of reasons why not to get a Medicare Advantage plan is pretty lengthy. They include:

  • Plan complexity
  • Limits on service providers
  • Extra fees
  • State-specific coverage

Plan complexity is probably the biggest issue for most people. Since Medicare Advantage plans offer more choice, they also become more complex.

Different plan structures can result in different coverage, as well as limits and extra fees. You’ll need to carefully go through the fine print to make sure you understand exactly what your plan covers and what it doesn’t.

Limitations on providers is another issue. Original Medicare doesn’t limit your choice of professionals. Medicare Advantage HMO restrict your coverage to in-network providers.

A PPO plan offers more choice, but you could end up paying more for care delivered out of network. As a result, you might pay more with a PPO plan.

Extra fees are another common issue. Medicare Advantage plans may look less expensive on the surface. They combine everything from Original Medicare with more benefits and often don’t have deductibles.

Even their premiums may be low. Some plans don’t have premiums. If you check the fine print, though, you may see co-pays, deductibles for prescription drugs, and more.

There’s also the issue of seeing providers outside of the network. Depending on your plan, that could mean you have less or no coverage. That increases your out-of-pocket costs.

Finally, each state has rules around Medicare Advantage plans. Specific coverage may only be offered in some areas. Original Medicare offers similar coverage all across the United States.

Is a Medicare Advantage Plan the Right Choice?

Now you’re asking, “Should I get a Medicare Advantage plan?” The answer depends on you and your needs.

If you want more extensive coverage, then a Medicare Advantage plan could be the right choice. You’ll need to carefully review costs and coverage, though.

Keep in mind that if you have a Medicare Advantage plan, you can’t get Original Medicare or a Medigap plan at the same time.

It is always possible to switch from a Medicare Advantage plan back to Original Medicare. As your health needs evolve, you may need to change your plan as well.

Look Out for Your Health

Getting a Medicare Advantage plan is sometimes the right move for Americans like you. There are both advantages and drawbacks to these plans, so do your research. Finding a healthcare plan that fits your needs is key to maintaining your health.

Looking for more tips on health insurance and how to maintain your good health? Check out our archives! We have plenty of in-depth articles to help you stay healthy and happy.

katy petter

Passionate health content writer dedicated to simplifying complex medical topics and promoting wellness. With expertise in nutrition, fitness, and medical breakthroughs, I create informative and engaging content to empower readers in their journey to better health. Let's inspire a healthier world together.

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