Medicare Advantages & Disadvantages
Be informed about Medicare's advantages and disadvantages to make better decisions.
Advantages
Medicare Advantage plans generally have a very low monthly premium, and in large metropolitan areas, the monthly premium can be as small as $0 per month.
In addition, Medicare Advantage plans put a limit on how much you will pay out of pocket each year. Once you reach your maximum out-of-pocket limit, the plan pays 100% of the Part A and Part B costs.
Bottom line: In some cases (remember, your individual needs may be different) your annual costs will be less with a Medicare Advantage plan than Original Medicare with a Supplement.
In addition, Medicare Advantage plans put a limit on how much you will pay out of pocket each year. Once you reach your maximum out-of-pocket limit, the plan pays 100% of the Part A and Part B costs.
Bottom line: In some cases (remember, your individual needs may be different) your annual costs will be less with a Medicare Advantage plan than Original Medicare with a Supplement.
Disadvantages
Some people just don’t like having co-pays. They would rather pay a flat monthly payment for a Medicare Supplement, and then sleep at night knowing that if they have to use their Medicare coverage, they will not have to pay co-pays or deductibles.
It’s a good idea to compare your annual cost for a Medicare Supplement to the combined cost of co-pays you would pay in any given year and figure out what will cost more. Of course, this is hard to do because you don’t always know if you will have a medical need each year.
Some will say, “I’m super healthy…I never go to the doctor.” If that stays true next year, then Medicare Advantage will cost you less. But what if? Make sense?
It’s a good idea to compare your annual cost for a Medicare Supplement to the combined cost of co-pays you would pay in any given year and figure out what will cost more. Of course, this is hard to do because you don’t always know if you will have a medical need each year.
Some will say, “I’m super healthy…I never go to the doctor.” If that stays true next year, then Medicare Advantage will cost you less. But what if? Make sense?
Coverage
Advantages
Medicare Advantage plans must cover everything that Medicare will cover. So that’s never a worry.
In addition, Advantage plans may offer other benefits that Medicare doesn’t cover like:
In addition, Advantage plans may offer other benefits that Medicare doesn’t cover like:
Dental
Vision
Hearing
Gym Membership
Over-the-counter health catalogs
Podiatry
Chiropractic
Vision
Hearing
Gym Membership
Over-the-counter health catalogs
Podiatry
Chiropractic
In addition, most Advantage plans include the prescription drug (Part D) coverage as part of the plan.
Disadvantages
Medicare Advantage plans often will require prior authorization before services are rendered. Whereas Original Medicare is a little more straightforward with less hoops to jump through.
A Medicare Advantage plan can restrict certain coverage limits. For example, if your doctor recommends that you have eight physical therapy sessions due to a recent outpatient procedure, the plan can come back and restrict your physical therapy visits to five based on “customary and usual”. Your doctor can always push back on the plan, but some don’t like having the headache of this type of thing.
A Medicare Advantage plan can restrict certain coverage limits. For example, if your doctor recommends that you have eight physical therapy sessions due to a recent outpatient procedure, the plan can come back and restrict your physical therapy visits to five based on “customary and usual”. Your doctor can always push back on the plan, but some don’t like having the headache of this type of thing.
Travel
Advantages
More and more, Medicare Advantage plans are starting to get more flexible with travel. For example, some offer foreign travel emergency coverage. Original Medicare doesn’t offer that.
For example, you are taking your Amazon jungle safari, and you slip and fall. Some Medicare Advantage plans will reimburse you (minus the co-pays of course) for the Air Ambulance ride and hospital fees you incurred in Brazil.
In addition, some Advantage plans are starting to offer programs that allow you to make your plan portable to other states and counties. And PPO plans are offering nationwide networks.
Bottom line: Medicare Advantage plans are becoming more flexible with travel, both in the US and abroad.
For example, you are taking your Amazon jungle safari, and you slip and fall. Some Medicare Advantage plans will reimburse you (minus the co-pays of course) for the Air Ambulance ride and hospital fees you incurred in Brazil.
In addition, some Advantage plans are starting to offer programs that allow you to make your plan portable to other states and counties. And PPO plans are offering nationwide networks.
Bottom line: Medicare Advantage plans are becoming more flexible with travel, both in the US and abroad.
Disadvantages
One of the biggest disadvantages of Medicare Advantage plans is the restrictions it places when you’re traveling (both in the U.S. and abroad).
If you enroll in an HMO Advantage plan, then you will only have emergency (including urgent care) coverage outside of the network of doctors and hospitals.
Again, for some, this may not be a big deal. But if you have a winter home and a summer home, and you split your time between the two, then an HMO Advantage plan may not be a good fit.
If you enroll in an HMO Advantage plan, then you will only have emergency (including urgent care) coverage outside of the network of doctors and hospitals.
Again, for some, this may not be a big deal. But if you have a winter home and a summer home, and you split your time between the two, then an HMO Advantage plan may not be a good fit.