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](https://www.firstquotemedicare.com/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.
FAQ: Pros and Cons of Medicare Advantage Plans vs. Original Medicare
What are Medicare Advantage plans?
Medicare Advantage plans are an alternative to Original Medicare (Parts A and B) offered by private insurance companies. These plans provide the same benefits as Original Medicare and often include additional benefits, such as prescription drug coverage.
How do Medicare Advantage plans differ from Original Medicare?
Medicare Advantage plans are offered by private insurance companies, whereas Original Medicare is provided directly by the federal government. While both cover the same basic services, Medicare Advantage plans may offer additional benefits and vary in cost, coverage, and provider networks.
What are the advantages of Medicare Advantage plans?
- Comprehensive Coverage: Many plans include benefits beyond what Original Medicare offers, such as dental, vision, and prescription drug coverage.
- Cost Control: Some plans may have lower out-of-pocket costs compared to Original Medicare.
- Plan Variety: There are various types of Medicare Advantage plans (e.g., HMOs, PPOs) that cater to different needs and preferences.
- Annual Plan Changes: Beneficiaries can switch plans during the Annual Election Period to better suit their changing health needs.
What are the disadvantages of Medicare Advantage plans?
- Network Restrictions: Some plans require you to use a network of doctors and hospitals, which can limit your choices.
- Complexity: Understanding and comparing the various plans can be time-consuming and confusing.
- Cost Variability: While some plans offer lower premiums, they may have higher deductibles or copayments.
- Availability: The availability of plans can vary by location, and not all plans are available in all areas.
Can I switch from Medicare Advantage to Original Medicare?
Yes, you can switch from a Medicare Advantage plan to Original Medicare during the Annual Election Period (October 15 to December 7) each year. You can also switch during the Medicare Advantage Open Enrollment Period (January 1 to March 31).
Is prescription drug coverage included in Medicare Advantage plans?
Many Medicare Advantage plans include prescription drug coverage (Part D). However, not all plans offer this benefit, so it's important to check the details of each plan.
Who should consider enrolling in a Medicare Advantage plan?
Medicare Advantage plans are a good option for individuals who want more comprehensive coverage and are willing to use a network of providers. These plans are also suitable for those who prefer the convenience of having all their Medicare benefits bundled into a single plan.
Who might prefer to stay with Original Medicare?
Individuals who value the freedom to choose any doctor or hospital that accepts Medicare without network restrictions might prefer Original Medicare. It is also a good option for those who do not want the additional complexity of comparing and managing different Medicare Advantage plans.
Can I enroll in Medicare Advantage if I have a chronic condition?
Yes, there are Special Needs Plans (SNPs) within Medicare Advantage designed specifically for individuals with certain chronic conditions, those who are eligible for both Medicare and Medicaid, or those who reside in a nursing home.
What happens if I need care outside of my Medicare Advantage plan’s network?
If you have an HMO plan, you may have to pay the full cost for out-of-network care, except in emergencies. PPO plans typically offer some coverage for out-of-network care but at a higher cost.
How do I enroll in a Medicare Advantage plan?You can enroll in a Medicare Advantage plan during your Initial Enrollment Period when you first become eligible for Medicare, during the Annual Election Period (October 15 to December 7), or during a Special Enrollment Period if you qualify.
Are Medicare Advantage plans available everywhere?
The availability of Medicare Advantage plans varies by location. Not all plans are available in all areas, so it’s important to check what options are available in your region.
