Pros and Cons of Medicare Advantage Plans

There are many Medicare plans to choose from and navigating the web of options can be overwhelming. One of the biggest decisions to make is whether to sign up for Original Medicare or a Medical Advantage Plan. All too often Medicare Advantage Plans are misunderstood. Let’s explore some advantages and disadvantages of Medicare Advantage plans and discuss the best way to make an informed decision.

If you are concerned about whether a Medicare Advantage plan is right for you, depend on Team SJB to understand your unique needs and prescribe a solution. We will personally spend time getting to know your needs and design a policy for you. We have partnerships with all the major insurance providers, so we can manage the lowest cost policy or a policy that provides extra benefits or security to suit your needs.

What is a Medicare Advantage Plan?

Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by Medicare-approved private companies that must follow rules set by Medicare. Most Medicare Advantage Plans include drug coverage (Part D). Some plans offer coverage for things Original Medicare doesn’t cover, like vision, hearing, dental, and fitness programs (like gym memberships or discounts). There are different types of Medicare Advantage plans to choose from, including Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Private Fee-for-Service (PFFS), Special Needs Plans (SNPs), and Medical Savings Account (MSA). In many cases, you’ll need to use health care providers who participate in the plan’s network and service area for the lowest costs. These plans set a limit on what you’ll have to pay out-of-pocket each year for covered services, to help protect you from unexpected costs. 

What are the advantages of a Medicare Advantage Plan?

• All your coverage options are in one convenient plan. To get all the benefits of Medicare Advantage with Original Medicare, you would also need to enroll in a stand-alone Medicare Part D Prescription Drug Plan as well as a Medicare Supplement plan.
• Plans often provide more benefits than you would receive under Original Medicare.
• Medicare Advantage plans limit your annual maximum out-of-pocket expense. Once you have spent that maximum, you pay nothing for covered medical services for the remainder of the year.

What are the disadvantages of a Medicare Advantage Plan?

• Medicare Advantage plans are more restricted in terms of their provider networks so your freedom of choice in health care providers may be limited. Some plans give you more provider freedom, but those plans may have higher premiums and fees like copays and deductibles. Be sure to check each plan’s directory to see if your favorite hospitals or doctors are included.
• There may be additional fees including drug deductibles and specialist visit copays.
• You may need a doctor’s referral to see a particular specialist or to go through certain procedures, especially if your plan is an HMO.
• Medicare Advantage plans have the option to change their benefits every year. Each September you will be sent an Annual Notice of Change letter. If the changes don’t work for your situation, you can use the fall Medicare Annual Election Period to choose a different plan.