What are the Pros and Cons of enrolling in a Medicare Advantage Plan?

Know the Pros & Cons of Medicare Advantage Plans

People with Medicare Part A (hospital insurance) and Part B (medical insurance) can obtain their Medicare benefits in a different way via a Medicare Advantage plan, commonly known as Medicare Part C. Medicare Advantage plans are provided by private insurance firms that have signed a contract with Medicare and give at least the same level of coverage as Medicare Parts A and B and additionally add on other extra benefits and perks.

You might be wondering whether you should enroll in a Medicare Advantage plan or in Original Medicare. Because Medicare Advantage plans contain significant elements that many people find attractive as well as other aspects that may not match your unique preferences and/or lifestyle, there isn’t a straightforward answer. Let’s look at some of the key benefits and drawbacks of Medicare Advantage plans.

The Pros of Medicare Advantage plans

Medicare Advantage programs usually offer more benefits than Original Medicare.

Medicare Advantage plans are required to provide at least the same level of coverage as Medicare Parts A and B, and many plans include additional benefits. Coverage for routine vision, hearing aids, routine dental care, prescription drug coverage, and fitness center memberships are just a few examples.

Medicare Advantage plans may cost you less

You must continue to pay your Medicare Part B payment and may be charged an extra premium if you enroll in a Medicare Advantage plan. The premium for a Medicare Advantage plan is set by the insurer, and it might differ from one Medicare Advantage plan to the next. Premiums for certain Medicare Advantage plans may be as low as $0 (premium-free).

Medicare Advantage may also reduce your cost sharing. If you visit a primary care physician under Medicare Advantage, for example, you may be required to pay a $10 copayment. If you go to a primary care physician under Original Medicare, you may be charged a 20% coinsurance, which might be more than $10.

In addition, with a Medicare Advantage plan, your maximum out-of-pocket payment is limited. After you’ve spent the maximum amount, you won’t have to pay anything for covered medical treatments for the rest of the year. Because Original Medicare does not have a maximum out-of-pocket limit, your prospective costs are virtually endless.

In many cases, a Medicare Advantage plan is less expensive than the same coverage you’d get if you stayed on Original Medicare. You’ll need to enroll in a stand-alone Medicare Part D Prescription Drug Plan as well as a Medicare Supplement plan to enjoy some of the benefits of Medicare Advantage with Original Medicare. Original Medicare does not cover additional benefits like dental, vision and hearing even with a Medicare Supplement Plan and there is no “Maximum out of pocket”.

Medicare Advantage programs bring together all your health-care professionals in one place.

Medicare Advantage programs are often managed care plans with contracted health care providers. For instance, Medicare Advantage plans offered by Health Maintenance Organizations (HMOs). You must choose a Primary Care Physician (PCP) who will assist you in coordinating your care under these HMO plans.

Medication therapy management may be available in Medicare Advantage plans that include prescription drug coverage. This type of care coordination can be both convenient and beneficial to your health.

Medicare Advantage plans can act as a "one-stop shop" for all of your health and prescription drug needs.

The majority of Medicare Advantage plans include both medical and prescription medication coverage. Many companies also manage the supply of supplemental services including vision, dental, and hearing care. Working with a single plan administrator may be more convenient for you.

Cons of Medicare Advantage plans

Medicare Advantage plans may restrict your options for health-care providers.

You can travel to any doctor or facility that accepts Medicare and get the same level of Medicare coverage for covered services under the federally controlled Medicare program. Medicare Advantage plans, on the other hand, have a more limited network of providers. Your plan may not cover your medical costs if you go out of network, or your charges may not count toward your out-of-pocket maximum.

Some services and procedures may require a doctor's recommendation as well as plan authorizations under Medicare Advantage plans.

Medicare Advantage programs use a variety of methods to try to prevent people from abusing or reusing health care. Prior authorization may be required for hospital stays, home health care, medical equipment, and some complex operations. Before they would pay for services, Medicare Advantage plans frequently demand a referral from your primary care physician to see specialists.

Specific service areas are covered by Medicare Advantage plans.

Majority of Medicare Advantage plans have regional (rather than national) provider networks. To enroll you must spend at least 6 months of the year in the Medicare Advantage plan’s coverage region. This criteria may be tough to achieve if you split your time between properties in different areas.

In the end, Medicare Advantage plans may give you with more affordable coverage than you would otherwise obtain. The trade-off is that in order to get payment for covered services, you must follow the Medicare Advantage plan’s rules. People who need to see certain doctors or take certain medications can check beforehand to see if a plan is appropriate for you.

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