What are the negatives of a medicare advantage plan?

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.

Once you've made your selection, sign up for your new plan by calling Medicare at 800-633-4227, if you want to switch to Original Medicare, or by calling the insurer or an independent Medicare agent who offers products from multiple companies. But most of the costs for Medicare Advantage plans come from copays, coinsurance, deductibles, and other out-of-pocket expenses that arise as part of the overall care process. While a consolidated Medicare Advantage plan may seem like a better alternative to Original Medicare, it has disadvantages. If you're one of the 63 million Americans enrolled in Medicare, you're probably being inundated with marketing proposals for Medicare Advantage plans, which offer managed care with low or no premiums.

Critics of Medicare Advantage plans say global risk financial incentives encourage providers and health plans to skimp on health care, refusing, for example, to pay for certain health screenings or extended nursing home stays not required by Medicare to save money. The Medicare program covers 62 million people with disabilities and people 65 and older, almost 42% of whom are enrolled in Medicare Advantage plans, policies provided by private insurance companies that contract with the Medicare program. While Medicare Advantage plans are popular, 33 percent of the nation's Medicare beneficiaries are enrolled in Medicare Advantage plans, they're not for everyone. The other parts of Medicare Part C, also known as Medicare Advantage, and Part D prescription drug coverage are optional and offered by private insurers.

According to the Kaiser Family Foundation, most people have an average of 39 Medicare Advantage plans to choose from. With a Medicare Advantage plan, you may have coverage for things that Original Medicare doesn't cover, such as fitness programs (gym memberships or discounts) and some vision, hearing, and dental services (such as routine checkups or cleanings). Many Medicare Advantage plans also include prescription drug coverage, so you can use your policy to access generic and brand name drugs. However, dealing with different aspects of Medicare, such as Medicare Part A, Part B, independent prescription drug coverage, and Medicare Supplement Insurance, can be overwhelming.

For example, even with a Medicare Advantage plan, Part B must be paid separately, although in some cases, at a reduced premium. But the managing partner of North Shore Insurance Brokers, Ina Goldberg, disagrees and makes the argument in favor of original Medicare rather than a Medicare Advantage plan. What makes Medicare Advantage plans bad is that they have more restrictions than Original Medicare on which doctors and medical centers you can use. Medicare Advantage plans have an annual limit on their out-of-pocket costs for all Part A and Part B services.

Elise Woehl
Elise Woehl

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