The Downsides of Medicare Advantage Plans

Before deciding to purchase a Medicare Advantage plan, it’s important to know the downsides:

Anyone who applies for a Medicare Advantage plan must voluntarily give up Medicare Part A and Medicare Part B Insurance Coverage.

Giving up Medicare Part A and Medicare Part B is necessary, because it allows the person to sign up with the insurance company that is selling the Medicare Advantage plan. This is a potentially dangerous sacrifice, considering the insurance company is not obligated to renew their contract with Medicare each year. If the insurance company did drop out of their Medicare Advantage contract, you would be dis-enrolled from that Medicare Advantage Plan.  At that point you would only have 63 days to either sign up for a alternative advantage plan or be assigned to one by default.

With Most Medicare Advantage Plans Your Doctor Must be Part of Their Network

Most Medicare Advantage plans do not allow members the right to choose their own doctor. This means healthcare services will only be covered if they are performed by a doctor that is approved by the Medicare Advantage insurance company. There are no exceptions for those who want to see a doctor that came highly recommended or seeing a doctor who specializes in certain health problems. Basically, you would be leaving your well-being in the hands of those who decide which doctors are approved and which are not.

Medicare Advantage is a Medicare Replacement, Not a Medicare Supplement.

Medicare Supplement Insurance is used to supplement Medicare Insurance plans. Medicare Advantage, on the other hand, does not supplement existing Medicare. Instead, it replaces Medicare insurance altogether. It’s also important to note that Medicare Advantage plans contain gaps, so members are still responsible for paying deductibles and co-pays. The only way these gaps can be avoided is by staying on Medicare Part A and Medicare Part B and purchasing traditional Medicare Supplement Insurance.

Medigap High-deductible Plan F  (vs)  Medicare Advantage Plan

When you qualify for Medicare, the big dilemma is trying to understand your options. While you’ll have a choice of Medigap Plans, and most beneficiaries have a choice of Medicare Advantage Plans, you might say the two options are “worlds apart.”

Medigap Plans Work with Medicare Part A and Part B to Fill in Coverage Gaps.

There are 10 different types of Medigap Plans that are standardized. The most popular one is Medigap Plan F, and it comes in two varieties in many states. There’s a standard Plan F with comprehensive benefits, and a high-deductible version. That means you’ll have to pay for a certain amount of non-preventive health care every year before the plan pays for other services. In 2013, the deductible is $2,110. Recommended preventive health care services are now covered by Medicare, so a Medigap Plan will help with other types of health care.

Advantage Plans Do Not Have Standardized Benefits and Medigap Plans Do.

You could buy a Medigap Plan F, for instance, from any insurance company, and it would have identical benefits. Advantage Plans set independent rules and regulations, so you’ll need to read each plan separately.

Advantage Plans offer the same coverage as original Medicare, but you cannot combine an Advantage Plan with a Medigap Plan. So, you can’t use a Medigap Plan to fill coverage gaps. Advantage Plans often provide more benefits than original Medicare, but you’ll have to read the individual policy for specifics.

To see which plan will provide the health care you need, compare both Medigap and Advantage Plans. You can read more about both options here on our site. Not all plans are available in every state, though. You can request an instant quote to see which Medigap Plans are available in your area.

How a Medicare Advantage Plan Can Result in Poor Care and Higher Costs.

Anyone who applies for a Medicare Advantage plan must voluntarily give up Medicare Part A and Medicare Part B Insurance Coverage.

Giving up Medicare Part A and Medicare Part B is necessary, because it allows the person to sign up with the insurance company that is selling the Medicare Advantage plan. This is a potentially dangerous sacrifice, considering the insurance company is not obligated to renew their contract with Medicare each year. If the insurance company did drop out of their Medicare Advantage contract, you would be dis-enrolled from that Medicare Advantage Plan and would have to start over looking for another one that met your needs adequately.

Most, if not all Medicare Advantage plans have a network of doctors, clinics and hospitals. It may be either a PPO or HMO network. In most cases, you would need a referral to see a specialist. Hospitals, doctors and clinics can also drop out of any particular Medicare Advantage plan at their leisure, leaving you, the Medicare Advantage recipient, the possibility of having to pay out-of-network costs or possibly the full cost of care.

Medicare Supplement Insurance is Used to Supplement Medicare Insurance Plans – Not Replace It.

Medicare Advantage, on the other hand, does not supplement existing Medicare. Instead, it replaces Medicare insurance altogether. It’s also important to know that Medicare Advantage plans contain gaps, so members are still responsible for paying deductibles, co-insurance and co-pays and, copays and co-insurance can be much higher for going out-of-network. The only way these gaps can be avoided is by staying on original Medicare Part A and Medicare Part B and purchasing a traditional Medicare Supplement policy.

Many Top Experts Agree that, Medicare and Medicare Supplement Insurance is preferable to Medicare Advantage Plans because you have the Freedom to Choose Any Doctor or Hospital anywhere in the United States. No Deductibles. No Co-Payments. No Referrals Necessary. No Claims Forms and one monthly premium. There is 100% Coverage with No Remaining Bills to pay if you purchase Plan F while the High Deductible F plan is significantly less costly.

Neil Primack – Your South Florida Medicare Supplement, Advantage Plan & Medigap Coverage Expert!