In 2024 54% of Medicare beneficiaries chose to enroll in a Medicare Advantage plan. Why are they so popular? Is a Texas Medicare Advantage plan right for you? Here are the pros and cons of enrolling in a Medicare Advantage plan:
Pros
Additional Benefits
Many seniors cite the additional benefits they receive through an Advantage plan as their reason for enrolling. Advantage plans must provide the same basic benefits as Original Medicare, but insurers can choose to offer additional benefits that Original Medicare does not offer.
Since Advantage plans are offered by private insurers, supplemental benefits will vary by plan and insurance carrier. The most popular benefits offered with an Advantage plan are vision, hearing, and dental coverage. Advantage plan enrollees may also enjoy access to free gym memberships and wellness programs. Some plans include additional benefits such as:
- Transportation to medical appointments
- In-home meal delivery after hospital stays
- Massage and chiropractic benefits
- Over the counter allowance to purchase OTC products
- Gift cards or rewards for completing annual preventive services
Ease and Affordability of an All in One Plan
When you enroll in an Advantage plan (also known as Part C), your Part A and B as well as your Part D prescription coverage are rolled into one plan with one monthly premium. You must be enrolled in Part A and B to enroll in a Medicare Advantage plan, and you will still pay your monthly Part B premium in addition to the Advantage plan premium.
Many seniors consider these plans to be more affordable, with some insurers offering a low or even $0 monthly premium. Some plans offer Part B give back dollars to help you pay your monthly Part B premium. Unlike Original Medicare, Advantage plans have an annual out of pocket maximum which caps the amount you have to pay out of pocket every year. Many seniors like knowing there is a limit to what they might have to spend.
Medicare Advantage Special Need Plans
There are Medicare Advantage Special Needs Plans (SNP’s) for those who qualify:
- C-SNP’s: Individuals with certain chronic conditions may qualify for a Chronic Condition Special Needs Plan (C-SNP). These plans are designed to focus on providing care for individuals with specific health issues. They might offer lower prescriptions costs for drugs needed to treat the condition, access to doctors and hospitals who specialize in the condition and lower copays for these visits. The C-SNP may provide a Care Coordinator to work with the patient and their doctors to help ensure better health outcomes.
- D-SNP’s: there are also Advantage plans for beneficiaries who are eligible for both Medicare and Medicaid. These Dual Eligible Special Needs Plans (D-SNPs) can help coordinate healthcare at lower costs for individuals who qualify.
Not all C-SNP and D-SNP plans are available in all areas.
Cons
You Must Use Doctors in the Plan’s Network
Every Advantage plan has its own unique provider network. You must see doctors, specialists, and hospitals within the plan’s network. Depending on the type of plan you have, HMO or PPO, you may have no coverage to go outside of the network, or you may pay higher out of pocket costs if you do. One reason some Medicare beneficiaries choose to stay with Original Medicare is because they want greater choice in the healthcare providers they see and don’t want to be restricted by an Advantage plan’s network.
Prior Authorizations and Referrals
Prior authorizations and referrals are tools used by Advantage plans to help manage care and costs. Some plans may require preapproval for certain procedures, known as prior authorization. They may require referrals before you can see certain specialists. Original Medicare does not have these requirements which some beneficiaries believe slows down or limits access to care.
Medicare Advantage Plans Change Every Year
Advantage plans change every year. This can include changes to out of pocket costs, covered benefits, the drug formulary, and the provider network. If you do enroll in an Advantage plan you will receive an Annual Notice of Change from your insurer every September. It’s important to review this notice for any changes that could be detrimental to you. If your plan changes, or your circumstances or health have changed, you may need to shop for different coverage during Medicare’s Fall Open Enrollment.
Medicare Advantage Plans Aren’t Right for Everyone
A licensed local Medicare agent can help you determine if a Medicare Advantage plan is right for you. They will review your healthcare needs including which doctors you see, which medications you take, your lifestyle including how frequently you travel, and your budget.
The dedicated team at Healthcare Educators makes Medicare easy. We will educate you on your options and help you enroll in in the Medicare coverage that best suits your needs. Contact us today.