Do Some People Think Medicare Advantage Plans Are Bad?

Some Medicare beneficiaries may think Medicare Advantage plans may not be a good fit because some plans may feature a limited network of providers. Some beneficiaries may want additional benefits that aren't available with Medicare Advantage plans in their area.

It's important to note that while some Medicare Advantage plan enrollees dislike Medicare Advantage plans because of a personal experience, millions of Medicare beneficiaries find a Medicare Advantage plan that works for their needs. In 2023, just over half of all Medicare beneficiaries are enrolled in a Medicare Advantage plan.¹

Some Plans May Feature a Network of Providers

Medicare Advantage plans are also known as Medicare Part C. Medicare Advantage plans are sold by private insurance companies, and they combine all of your Medicare Part A and Part B (known together as Original Medicare) benefits together in a single plan. 

Some insurance companies offer plans with a network of preferred doctors and providers in order to keep health care costs down and to help reduce high out-of-pocket costs for beneficiaries. You mind find Medicare Advantage plans as a health insurance option if you prefer the option to receive healthcare with any provider who accepts Medicare.

Medicare Advantage plans cover Original Medicare benefits but can also cover extra benefits not offered by traditional Medicare. These additional benefits may include things like prescription drug coverage, but plan benefits can vary depending on where you live.

Before enrolling in a Medicare Advantage plan, be sure to consider the following options to help find the right Medicare Advantage plan for you:

• Is the plan accepted by your preferred doctors or hospitals? A licensed insurance agent can help you view a list of in-network providers that are covered by plans available in your ZIP code.
  
  
• If you find a plan that covers extra benefits like dental or hearing, are there network restrictions on where you can use these benefits?
  
  
• If you find a plan that covers prescription drugs, are your drugs covered on the plan formulary (list of covered drugs)?

Unlike Original Medicare, which allows beneficiaries to see any healthcare provider who accepts Medicare, Medicare Advantage plan enrollees may be restricted to a specific list of in-network providers.

Two common forms of Medicare Advantage plans are HMO plans and PPO plans. Depending on which type of plan you have, you may pay higher out-of-pocket costs when receiving care outside of your plan network.

Explore a plan's list of participating providers before applying for a plan. You may find a plan that covers your preferred doctors.

Medicare Advantage Plan Costs Vary

Medicare Advantage plans may include several types of costs that can vary from one plan to the next. These expenses can include things like monthly premiums and deductibles.

• Copayments and coinsurance: As with Original Medicare, Medicare Advantage plans often require copayments or coinsurance for various services. This means you may have to pay a portion of the cost every time you access healthcare.
  
  
• Deductibles: Some Medicare Advantage plans come with deductibles that must be met before your plan begins covering your medical expenses. Understanding plan deductibles can help you understand what to expect to have to pay for your medical costs.
  
  
• Out-of-network charges: If you receive care from a provider outside of your plan's network, you may face higher fees or even no coverage at all.

Beneficiaries considering a Medicare Advantage plan can carefully review all aspects of a policy with a licensed insurance agent and compare local plan options before making a decision.

Some Plans Won't Cover Care While Traveling

You may be able to find Medicare Advantage plans that offer greater flexibility for receiving covered care while traveling. Depending on the type of plans available where you live, you may be able to find a plan that allows you to access covered care with no network restrictions, as long as the provider accepts Medicare and the plan terms.

Be sure to find out what types of network restrictions a plan includes before you enroll.

Can I Drop My Medicare Advantage Plan and Go Back to Original Medicare?

Yes, there are typically two Medicare enrollment periods when you can drop your Medicare Advantage plan and return to Part A and/or Part B coverage:

• During the annual fall Medicare Open Enrollment Period (October 15 to December 7 each year)
• During the annual Medicare Advantage Open Enrollment Period (January 1 to March 31 each year)

You may be able to drop or switch your Medicare Advantage plan outside of these enrollment periods, but typically you can only do so if you are new to Medicare or a Medicare beneficiary who has recently moved or lost coverage.

Why Would I Switch to a Medicare Advantage Plan?

You might consider switching because some Medicare Advantage Plans may include extra benefits like dental, vision, hearing aids, fitness programs or prescription drug coverage.¹ 

Additionally, Medicare Advantage plans have an out-of-pocket maximum which limits your yearly spending on covered medical expenses.

Conclusion

Some Medicare beneficiaries may view Medicare Advantage plans as an attractive choice, however there are drawbacks associated with them. Get help deciding for yourself whether Medicare Advantage plans might be right for your needs.

We represent carriers such as Humana, UnitedHealthcare®, Anthem Blue Cross and Blue Shield, Aetna, Cigna Healthcare, Wellcare, or Kaiser Permanente.