Medicare Advantage plans are becoming increasingly popular due to the way they are funded. The premiums for these plans are either low or non-existent because Medicare pays the insurer every time someone signs up. This makes it beneficial for insurance companies to encourage enrollment in Medicare Advantage plans, as they receive money from Medicare. However, these plans can become expensive if you're sick due to 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, and if you decide to switch to a Medigap policy, there are often lifetime penalties. The growth of these plans is also due to strong investment by health insurance companies in geographical expansion and commercialization. Industry reports show high consumer satisfaction rates with Advantage plans, highlighting additional services offered by many plans such as health clubs, dental care, vision and hearing. Medicare website offers “suggestions too broad to enroll in MA when more nuance is required” (Medicare Rights Center). Michael Rainey, commentator for The Fiscal Times, explains that private insurers are responsible for managing their plans to guarantee profits. It's important to keep in mind that with traditional Medicare and Medigap, you'll also need Part D prescription drug coverage.
If you decide that the Medicare Advantage plan isn't for you, you have the right, under federal law, to purchase any Medigap plan if you switch to Original Medicare within 12 months of the date you first joined a Medicare Advantage plan. Studies have concluded that these plans are outperforming original Medicare in areas such as preventive care, hospital readmission rates, nursing home admissions and mortality rates. Medicare email campaigns have been criticized by advocacy groups for drawing more attention to MA plans. Philip Moeller, PBS contributor, explains: “Even when I knew that a specific plan offered new non-medical benefits, they were often not included in the Plan Finder or were not clearly explained (PBS). At that time, you can switch to traditional Medicare with a Medigap, but Medigap may charge you a higher fee than if you had initially enrolled in a Medigap policy when you first qualified for Medicare. Medicare Advantage may be right for some people, but it's important to know and understand all of your options before making a decision.
There are some difficulties that many Medicare Advantage members don't discover (the limitations of their Medicare Advantage plans) until they get sick. And one video touted “additional new benefits” - a reference to a new range of non-medical supplemental benefits that are beginning to be implemented in the Advantage program and are not yet widely available. The Department of Education is required under statutes governing Medicare to 'promote active and informed selection' among Medicare plan coverage options. However, there is no built-in limit to out-of-pocket costs in original Medicare; the only way to get it is to get supplemental coverage. You'll find that many plans unexpectedly don't cover certain expenses when you get sick, resulting in unforeseen out-of-pocket expenses for you. And what they pay can vary depending on your general health condition.