Advantages and disadvantages of Medicare advantage plans
Medicare Advantage plans really are a good alternative to basic Medicare health insurance. Added benefits and cost savings is why Medicare advantage HMO and PPO plans are a very popular and economical choice for seniors. They are however typically ‘managed care’ insurance, offered as HMO, PPO, PFFS plans, which also brings some limitations or ‘disadvantages’. Generally spoken, an advantage plan may not be for you, if you want to be completely free in your choice of doctors.
All Medicare Advantage plans will give you at least the same medical care benefits as traditional Medicare, regardless of the insurer. On the other hand, the major benefit to Medicare Advantage policies is really that many plans cover things on top of the standardized benefits, in particular prescription drug coverage, vision, dental and hearing therapy, which the original Medicare program does not cover.
The advantages of Medicare Advantage plans
There are two main reasons why Medicare advantage plans are such a popular choice for Medicare beneficiaries. First, many medical services that are not covered by original Medicare, such as prescription drugs, hearing, dental or vision are included, or can be added to many Medicare advantage plans at no or a moderate monthly premium. Second, Medicare Advantage plans do not have a health check or underwriting to go through, so almost anybody, even with pre-existing conditions, may enroll.
While not all Medicare advantage plans include prescription drug coverage or benefits such as vision, hearing or dental, you’ll likely find that many insurance companies do offer these as optional benefits. If you instead select Medicare supplemental insurance to add additional coverage to your original Medicare, you won’t have these options, as supplemental insurance policies are standardized, and none of the 10 available ‘Medigap’ plans does offer these benefits, not even for an extra fee. You may, however, purchase separate insurance policies from private insurance companies in order to be covered.
If you are looking for an advantage plan that includes prescription drug coverage (so called ‘MA-PD’ plans), ensure that any medication you need to take regularly is covered, as quite a few enrollees have actually been surprised in a bad way after they realized that the insurance plan they had enrolled in failed to cover the prescriptions they really needed.
The disadvantages of Medicare Advantage plans
If you are deciding on Medicare Advantage, you typically have the choice of HMO (Health Maintenance Organizations), PPO (Preferred Provider Organizations), PFFS (Private Fee For Service Plans) and Medicare Special Needs Plans. HMO (Medicare Health Maintenance Organizations) and PPO (Preferred Provider Organizations) are the most popular choice. Those two kinds of Medicare Advantage plans use networks of doctors along with other medical providers that have agreed to provide treatment for members of the plan. Generally, enrollees of a HMO plan must select their medical care providers from this network system and need to select a primary care physician to manage their care, while PPO insurance plans allow for in-network health care providers (at a lower co-pay) along with out-of-network providers. Members receiving health care services outside the network are usually required to pay a higher co-payment.
Several insurance carriers offer also Medicare advantage plans known as PFFS (private fee for service plans), that will allow you to use whatever medical specialist or benefit from any type of Medicare-approved health related clinic without having a referral, but you will have a higher co-payment.
Another disadvantage is that not all plans are available in every geographic area. While in many parts of the nation, especially in large city areas, you will have a broad choice of various Medicare Advantage plans, only a handful or even none may be available to you, if you live in a remote location. In case you are lucky enough to find numerous options in your geographical area, make sure you check out each plan’s cost and insurance coverage.
After the Initial Enrollment period passes, you can only enroll in a Medicare Advantage Plan between October 15 and December 7 each year. Your coverage will start on the first day of the month after you sign up.
