Are medicare advantage plans too good to be true?

Medicare Advantage Plans Are Certainly Worth the Zero Dollar Premium. However, it's your choice to decide if coverage is right for you and your budget. The value of a Medicare Advantage plan depends on your location, your health care needs, your budget, and your preferences. Medicare Advantage can get expensive if you're sick because of uncovered copays.

In addition, a plan may offer only a limited network of doctors, which can interfere with a patient's choice. It's not easy to switch to another plan. If you decide to switch to a Medigap policy, there are often lifetime penalties. For Many Older Americans, Medicare Advantage Plans May Work Well.

A JAMA study found that Advantage members often receive more preventive care than those receiving traditional Medicare. Advantage plans compete not only for cost, but also for quality care delivery, says Kenton Johnston, PhD, associate professor of health management and policy at the University of Saint Louis, co-author of the study. A zero-premium Medicare Advantage plan may seem too good to be true, but it exists. If you have Medicare Advantage, you no longer use Original Medicare.

This is because Medicare Advantage actually replaces Original Medicare completely. Medicare Advantage plans encapsulate the benefits of Original Medicare (Medicare Part A, your hospital insurance and Medicare Part B, your outpatient insurance) plus additional benefits such as dental, vision, hearing, wellness programs, etc. Medicare Advantage plans (such as Medicare supplement plans) are designed to help limit your out-of-pocket expenses. However, unlike Medicare supplement plans, these Medicare Advantage plans are not standardized, so benefits can vary widely.

Private Companies Offer Medicare Advantage (Medicare Part C). Basically, Medicare pays these private companies (insurance companies) to bear their medical risks and costs. Because Medicare pays insurers, they can transfer cost-saving benefits to you in the form of lower monthly premiums. If that sounds too good to be true, it might be.

Even though their Medicare Advantage plan offers coverage, they almost always receive high out-of-pocket copayments and a low maximum benefit amount. Medigap plans also offer a flexible provider option, as coverage is accepted by any doctor or medical service that accepts Medicare, the vast majority. These Medicare Advantage plans may include coverage for prescription drugs, vision care, dental, hearing aids, and even a free gym membership. It's important to know that most beneficiaries will only receive a Medicare Supplemental Open Enrollment Period once in their lifetime.

Keep in mind that with Original Medicare and Medigap plans, you will still need Part D prescription drug coverage. The average doctor isn't a fan of Medicare Advantage because these plans put patients' financial risk in the doctor's hands. To help pay for things that Medicare doesn't cover, you can choose to buy supplemental insurance known as Medigap (or Medicare Supplement Insurance). If you have a limited budget and can't pay the monthly premiums of a Medicare supplement plan, then a Medicare Advantage plan with sufficient coverage for your health needs is a good deal.

Networks are restrictive, so you'll need to make sure your preferred doctors are in network before choosing a plan. For those who live in rural areas, where there are fewer doctors and hospitals, the Advantage plan's tight networks can be an obstacle to getting the care they need. In general, many Medicare Advantage policyholders don't like plans because they thought they were free. Original Medicare doesn't cover all of your medical expenses, while Advantage plans have cost-sharing requirements, but then limit your out-of-pocket costs.

When you enroll in a Medicare Advantage plan, you are still responsible for paying the Medicare Part B premium and cost-sharing. .

Elise Woehl
Elise Woehl

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