The number of Medicare beneficiaries who choose to enroll in Medicare Advantage (MA) plans continues to increase. The Kaiser Family Foundation reports that, in 2023, 51% of eligible Medicare beneficiaries are enrolled in an MA plan. The average beneficiary has access to over 43 different plans – the largest number of options ever available. There are several reasons for the growing popularity of these plans.
Access to Additional Benefits
Medicare Advantage plans are offered by private insurance carriers, and plan benefits can vary between insurers. Although plans must all offer the same basic benefits as Original Medicare, insurers can choose to provide additional benefits that Original Medicare does not offer. These can include:
- Dental
- Vision
- Hearing
- Gym memberships and wellness programs
- Transportation to medical appointments
- In-home meal delivery after hospital stays
- Massage and chiropractic services
- Over-the-counter allowances to purchase OTC products
- Gift cards or rewards for completing annual preventive services
Seniors often find these additional benefits appealing. Nearly 25% of MA plan enrollees cite supplemental benefits as their reason for choosing an MA plan.
Affordability and Ease
Beneficiaries often see Medicare Advantage plans as being more affordable. Many insurers now offer $0 premium plans and even Part B giveback plans that help pay a beneficiary’s Part B premium. MA plans also come with an annual out-of-pocket maximum. The federal government decides on a new maximum dollar amount each year. Many enrollees like knowing there is a cap on the amount they will have to pay out of their own pocket in any given year.
Many seniors also like the ease and simplicity of MA plans. Enrollment provides Medicare Parts A, B, and D drug coverage rolled into one plan with one monthly premium.
Possible Disadvantages of a Medicare Advantage Plan
Depending on your individual situation and the type of coverage you want, there could be some disadvantages to MA plans. There are two primary reasons why some Medicare beneficiaries choose to enroll in Original Medicare and not an MA plan.
Provider Networks
Other than for emergency care, MA plans require enrollees to use the healthcare providers within their network. Every plan’s provider network is different. Depending on the type of plan you have – HMO or PPO – you may have no coverage outside the network or you may face higher out-of-pocket costs when you seek care outside your network. Many Medicare beneficiaries who enroll in Original Medicare want greater choice in the doctors they see and do not want to be restricted by an MA plan’s provider network.
Referrals and Prior Authorizations
MA plans often use referrals and prior authorizations to manage care and costs. Some plans require referrals to see certain specialists. They may require pre-approval (also known as prior authorization) for some procedures. Some Medicare beneficiaries who enroll in Original Medicare prefer not to deal with these special requirements because they may slow down or limit their access to care.
Is a Medicare Advantage Plan Right for You?
To decide if a Medicare Advantage plan is right for you, consider your specific circumstances, including your healthcare needs, budget, and lifestyle. Since all Medicare Advantage plans are different, it’s important to ask questions about the coverage they offer.
- What are my out-of-pocket costs? Be aware of all out-of-pockets costs, including premiums, deductibles, copays, coinsurance, and the out-of-pocket maximum.
- Are my doctors in the network? Make sure all your preferred doctors, hospitals, and pharmacies are in the plan’s network. Does an HMO plan work for you or do you want to pay more to have a PPO plan with out-of-network coverage?
- How does the plan cover my health conditions? If you have any chronic health conditions, ongoing treatments, or upcoming tests, find out if the plan covers them and what the costs will be. You should ask if prior authorizations or referrals are a requirement.
- Will I have coverage if I travel? If you travel domestically or internationally or spend a lot of time at a vacation home outside your plan’s local service area, find out what your coverage will look like.
Finding the right Medicare coverage does not have to be difficult. The team at Healthcare Educators can show you all your options and help you compare a variety of plans. We make Medicare easy. Contact us today.