What Are the Advantages and Disadvantages of Medicare Advantage Plans?

While Medicare Advantage offers some improvements and extended coverage for some health services over Original Medicare, plans are so variable that choosing one can be complicated.

Medicaid Advantage plans are a part of Medicare known as Medicare Part C. These plans are offered by private insurance companies that have been approved by Medicare. Legally, a Medicare Advantage plan must provide all the same services that Original Medicare provides, including Part A (hospitalization, nursing home care and hospice) and Part B (doctor visits, medical tests and mental health care). However, these plans offer additional benefits not available under Original Medicare. There are also numerous versions of the plans to best suit your medical needs.

Advantages

• All Medicare Advantage plans offer coverage for vision, dental and hearing, which provide important services to those aged at least 65 or with disabilities.
• Many Medicare Advantage plans offer prescription drug coverage, which Original Medicare doesn’t provide. If you have Original Medicare and require prescription medicines, you need to buy a Medicare Part D plan. Seniors often select a Medicare Advantage plan because they prefer to pay for their health coverage and prescription drug costs in the same plan.
• Unlike Original Medicare, there are many different Medicare Advantage plans. If you pick a plan and decide you made a mistake, you can select a new Medicare Advantage plan or return to Original Medicare during the next open enrollment period.
• Many Medicare Advantage plans offer lower out-of-pocket costs than Original Medicare. Original Medicare includes a 20% coinsurance fee, which is covered by many Medicare Advantage plans.
• Many Medicaid Advantage plans offer memberships or discounts to fitness programs and gyms.
• You can join a Medicaid Advantage plan if you have a preexisting condition.
• These plans have a yearly limit on what you pay for out-of-pocket costs, unlike Original Medicare. Once you meet that limit, you pay nothing for Part A and Part B costs for the rest of the year.

Disadvantages

• With Original Medicare, you can visit a doctor in any state who takes Medicare. With a Medicare Advantage plan, you frequently need to use in-network doctors to obtain the lowest costs. Some Medicare Advantage plans don’t allow you to use any out-of-network medical providers.
• While there may be many Medicare Advantage plans available in your state, you can only choose a plan that is offered in the county where you live. Even if there’s a plan that you prefer in another county, you cannot select it. If you move out of the county where you live, you’ll need to choose a different Medicare Advantage plan.
• Some Medicare Advantage plans require that you get a referral to see a doctor and name a primary care physician.
• Some Medicare Advantage plans don’t provide prescription drug coverage, and if you try to purchase a plan separately, you will be booted out of that plan and returned to Original Medicare. If you’re in a Medicare Advantage plan that doesn’t offer prescription drug coverage, you can switch to one that does during the Medicaid Advantage open enrollment period between January 1 and March 31 each year.
• If you have a Medicare Advantage plan, you cannot select a Medicare Supplemental Insurance plan, also known as Medigap. Medigap plans are usually purchased by users of Original Medicare to help them pay for coinsurance fees and other costs and aren’t normally needed by Medicare Advantage plan members. However, most Medigap plans cover you when you travel outside the United States, while Medicare Advantage plans do not.