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Medicare Advantage, also known as Medicare C, is a popular option in the Medicare program. Medicare Advantage provides an alternative option for health insurance coverage through private insurance companies rather than the federal government. Medicare Advantage plans are available for older people and disabled adults who qualify for the original Medicare plans. When considering your options, it’s important to weigh the pros and cons while taking into consideration your budget and health care needs. Read on to learn more about what Medicare Advantage Plans are and the pros and cons of choosing this over traditional Medicare coverage.

What are Medicare Advantage Plans?

The Medicare program is available to adults 65 years or older, younger people with disabilities, and people with end-stage diseases. Medicare can be complex and split into different parts to cover specific services.

  • Medicare Part A (Hospital Insurance) covers inpatient stays, long-term care in a nursing facility, hospice care, and some qualified home health care coverage.
  • Medicare Part B (Medical Insurance) covers doctors’ visits, outpatient care, some medical supplies, and preventive services.
  • Medicare Part D (prescription drug coverage) covers the cost of prescription drugs and recommended shots or vaccines.

Medicare Advantage (MA) is a Medicare-approved plan that offers more options for health insurance coverage through private health insurance. Medicare advantage is often referred to as Medicare Part C. MA bundles together Part A, Part B, and Part D and can provide additional benefits that traditional Medicare doesn’t cover, such as dental, vision, and hearing. Because these plans are offered through private insurance companies, they are offered on an annual agreement which can change from one year to the next.

The Pros of Medicare Advantage Plans

During open enrollment, if you qualify for Medicare, it’s important to carefully research the plans available to make a decision that best fits your medical needs and your budget. There are a lot of benefits that can make choosing the Medicare Advantage plan a safer choice. Some of the benefits include:

Bundled Coverage Options

Original Medicare plans offer separate coverages for hospital insurance, medical insurance, prescription drug coverage, and Medigap coverage that you can purchase individually. By choosing Medicare Advantage, you can have all your coverage options in a simple and convenient all-in-one plan.

Low or No Monthly Costs

Medicare Advantage plans are offered to policyholders at lower or no monthly premiums. Many of the plans also offer low or no deductibles for care. Although the cost is not standardized and varies based on providers, specific plans, and zip codes, it is typically a very affordable option.

More Flexible Coverage Options

You can choose additional coverage options that are not available with traditional Medicare coverage plans. You can choose vision, dental, and hearing services. Some MA plans provide chiropractic care, gym memberships, and stipends for over-the-counter supplements, adding additional benefits to an already comprehensive insurance option. It’s a good idea to talk with a local Medicare agent to see what additional benefits are available in your area.

Lower Out-of-Pocket Limit on Medical Expenses

Unlike traditional medicare plans, Medicare Advantage has out-of-pocket limits that cannot exceed $7,500 a year for beneficiaries. You must see a provider or specialist within their network, and if you have to visit out of network, the costs can potentially increase. This can be very beneficial for those who may have medical conditions that require ongoing medical treatment.

Healthy Competition

Because multiple insurance providers are allowed to offer MA plans in each state, they will often compete for your business by offering great benefits and kickbacks – far beyond what is required. This means you will typically have several great options available at any given time.

The Cons of Medicare Advantage Plans

While there are many clear benefits to choosing the Medicare Advantage plans, it’s essential to review the cons, which may include:

Restrictions on Providers

There could be a limited availability of doctors and hospitals in-network for Medicare Advantage, potentially limiting choices for members. Medicare Advantage offers financial incentives to encourage you to use providers in the network except in emergencies. As with many other health insurance plans, you will typically end up paying higher fees if you visit an out-of-network provider. In contrast, with traditional Medicare, you can see any provider that accepts Medicare.

Additional Costs for Coverage

While Medicare Advantage does allow you to bundle coverages and consolidate costs, there are additional fees you may have to pay. Some of the additional fees may include prescription drug deductibles and copays for specialist visits. These fees will not be the same in every MA plan offered in your area.

Plans Are Not Standardized

Medicare Advantage plans are not standardized and can only offer specific coverage in certain service areas. If you move to a new state, your current Medicare Advantage plan may no longer be available. Your plan can change its premium, network, deductible, copays, and coinsurance annually. It’s important to review your current and upcoming coverage on a yearly basis.

How Does Medicare Advantage Work?

Medicare Advantage is provided through private companies that offer medical insurance. MA is only available to people who qualify for traditional Medicare plans. The private companies receive a fixed monthly amount from Medicare to cover the Medicare Advantage plan coverage they provide. These private companies must follow rules set up by Medicare to protect policyholders from incurring more expenses.

Each Medicare Advantage Plan can determine its out-of-pocket costs and set different rules for how members receive services. They may establish rules such as if you need a referral to see a specialist or which doctors, facilities, or suppliers are in-network for non-emergency or non-urgent care.  

How to Enroll in Medicare Advantage

Enrolling in Medicare Advantage plans can only occur during specific open enrollment periods throughout the year. The initial enrollment period for people joining Medicare for the first time can happen at any time. During this time, Medicare Advantage is available as well.

The Annual Enrollment Period (AEP) for Medicare is October 15 through December 7 every year- when people can join, switch, or unenroll from Medicare. AEP is the time when most individuals are choosing their Medicare coverage for the coming year. There is also an enrollment period for those already enrolled in Medicare Advantage to change their MA plan or even unenroll and change back to the original Medicare, from January 1 through March 31. Because Medicare Advantage is not standardized, additional special enrollment periods are available for people to make changes when they need to under special circumstances.

Choosing the right Medicare Advantage plan can seem overwhelming, and there are many things to consider. Medicare Advantage plans make it easy to select the coverage you need at an affordable rate. You can save money, bundle coverages, and add additional services to help you receive the care you need. Knowing the pros and cons of Medicare Advantage plans is a great start. A local Medicare agent will be able to help identify your available options and find additional benefits you may be missing out on.

Brighter Insurance offers free Medicare consultations with a licensed and local Medicare agent. Contact us today with any questions you may have or to schedule your free Medicare consultation.