Medicare Advantage Pros And Cons

See if Medicare Advantage is right for you

Meredith Miller
Published on
January 22, 2024
Updated on
January 22, 2024

Medicare Advantage is a great alternative to the Original Medicare (Parts A and B) offered by the federal government. Medicare Advantage plans are offered by private insurance companies and will offer more comprehensive benefits, with some Advantage plans including prescription drug coverage. However, Medicare Advantage is not right for everyone, which is why FirstQuote Medicare is here to help you weigh the pros and cons of Medicare Advantage.

Brief Overview Of Medicare Advantage Plans

Medicare Advantage plans come in many forms, just like private insurance. These include HMOs, which have a cheap network but no out of network coverage, PPOs, which have a smaller discount but out of network coverage, Medical Savings Accounts, Special Needs Plans and more.

There are choices out there for just about anyone. Within those types of plans, there can be a lot of variation in terms of what levels of coverage the plans have, how high the copays are, the premiums, the deductibles, the network, and anything else that might affect whether the plan is good for your needs.

Brief Overview Of How Advantage Works

Medicare Advantage works differently from Original Medicare. Under Original Medicare, the government runs the entire plan directly. Under Advantage, it is private insurance companies that create and operate the plans. The government then pays those companies for your care.

Private health insurance companies are required to cover the same Part A and Part B services as Original Medicare, but other than that they are free to make changes. For example, most of these plans choose to include prescription drug coverage, which is not a part of the government Medicare plan. You interact with the insurance company instead of the government when you file claims, make payments, and do everything else you need.

Medicare Advantage Pros and Cons

Looking at the pros and cons of Medicare Advantage can help you decide on whether to try it out. The biggest pro of Advantage is that it lets you make choices about your plan. Medicare tends to be one size fits all- there is just one plan with one set of benefits. With Medicare Advantage, you get a lot more scope to find a plan that is cheaper, has better coverage for your needs, or lets you keep doctors you like.

Medicare Advantage pros and cons include downsides as well. The cons are that they can be confusing to understand and that you may have to give something up to get a different plan. For example, plans with low premiums tend to have high deductibles, so they stop saving money if you have to use them a lot. Think about these Medicare Advantage pros and cons even before you turn 65. Medicare Advantage pros and cons might make the difference in your choice.

Advantages of Medicare Advantage

Let’s take a look at some of the biggest advantages of enrolling in a Medicare Advantage plan.

  • Freedom - You get the freedom to find a plan that you think matches your particular needs and preferences. This isn't possible with Medicare alone. That flexibility can extend to making the right choice for your budget, getting a good network for the kinds of services that you want to use, and more.
  • Continuity - You can treat the plan just like the insurance you are used to using. If you used to have regular insurance, then Advantage will feel very similar in terms of the paperwork, the customer support, and the documentation.
  • Control - You can switch between plans yearly in case you see something that you like better or a new plan appears.

Disadvantages of Medicare Advantage

As mentioned earlier, while Medicare Advantage may be a great fit for most, it’s definitely not right for everyone. Here’s a deeper look into some of the disadvantages of Medicare Advantage plans.

  • Availability - Availability can be limited. Depending on what you want and where you live, Advantage plans may be plentiful or uncommon. Insurance companies are not required to offer them, so it can be hard to predict what kind of choices will be around. This can also fluctuate from year to year.
  • Cost - The savings aren't always that good. The most common example is a low-premium plan with a large deductible. This is fine if you never use the plan, but if you have to utilize services, then you will need to pay a lot before you reach your deductible, negating the savings.
  • Effort - It will take a lot of time to learn about what local companies are offering and compare and contrast all of the available options.

Can You Change Your Medicare Advantage Plan After Enrolling?

You can switch, enroll, or disenroll in ]Medicare Advantage plans]( during the Annual Election Period (AEP) which takes place every year between October 15 and December 7. If you choose to switch plans, you won’t have to worry about disenrolling from your old plan, because it will happen automatically.

Make sure you decide on what you want before the end of the Annual Election Period. If you don't have an Advantage plan yet because you are just turning 65, you can sign up in the three months before or after you turn 65 as well as the month of your birthday.

Who Should Consider Medicare Advantage Plans

Advantage plans should be on the table for most people when they approach 65. You can make significant savings or get a plan that suits your needs a lot better than the standard offering. It can take some time to research what is available and how the plans work, so don't start too late. Remember that there are special needs plans for some circumstances like people who are also eligible for Medicaid, those in nursing homes, and those with some long-term chronic conditions.

Who Shouldn’t Consider Medicare Advantage

If you feel comfortable with the government Medicare plan and don't want to change it, that is also a fine decision. Advantage can add some complexity and extra work to your insurance, so if you are happy with what you have, then it is probably not worth the effort to switch things around. And of course, there is no need to consider it at all if you are still working and getting health insurance benefits from your employer.

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