The Pros and Cons of Switching to a Medicare Advantage Plan
This article was updated on: 01/25/2017
Medicare Advantage plans, also known as Medicare Part C, are one way for beneficiaries to receive their Medicare benefits. These plans are required to offer everything that’s covered under Original Medicare, Part A and Part B, with the exception of hospice care, and may include other benefits as well, such as prescription drug coverage, dental, and vision.
But is it right for you? Get more information on the pros and cons of Medicare Part C before you search for plans using Medicare.com’s obligation-free plan comparison tool.
How do Medicare Advantage plans work?
Medicare Advantage plans are offered by private insurance companies that are approved by Medicare. Every month, Medicare pays the private insurance company a fixed amount, and that company covers your costs, according to rules set by Medicare.
Medicare Advantage plans can come in many different types, and benefits may vary by plan. Many will include prescription drug coverage in a plan type known as a Medicare Advantage Prescription Drug plan. The different forms of Medicare Advantage plans include:
- Health Maintenance Organization (HMO)
- Preferred Provider Organization (PPO)
- Private Fee-for-Service (PFFS)
- Special Needs Plans (SNPs)
- HMO Point-Of-Service (HMOPOS)
- Medical Savings Account (MSA)
What are the downsides of Medicare Advantage plans?
Since Medicare Advantage plan coverage is administered through a private insurance company, the rules and guidelines can vary, which can lead to restrictions like these:
- The specifics of each Medicare Advantage plan depend on the insurance company. As a result, your Medicare Advantage plan may require higher out-of-pocket costs than with Original Medicare. Plan premiums, benefits, and copayments may change each year.
- The insurance company may require you to follow strict rules to get coverage for certain services or health products, like getting referrals to see specialists. You may have to change your doctor or hospital to one within the Medicare Advantage plan’s network for coverage, or you may have to pay a higher cost.
- Medicare Advantage plans have annual contracts with Medicare and can choose not to renew their contract for the following year.
What are the pros of Medicare Advantage plans?
- Some insurance companies could offer a $0 premium for the Medicare Advantage plan. Medicare Advantage plan availability will depend on the county and state in which you live.
- Beyond the benefits that Original Medicare offers, your Medicare Advantage plan may cover additional benefits that are not covered by Part A and Part B, such as vision or dental coverage.
- Each plan comes with a maximum out-of-pocket limit on how much you will spend on health costs each year. Once that limited is reached, you will pay nothing for covered services. Each Medicare Advantage plan could have a different limit, and that amount may change each year.
How do I choose a Medicare Advantage plan?
It’s up to you to determine which type of coverage is the right option. It’s important to read all of the details of each Medicare Advantage plan, including the fine print, and compare the different benefits, costs, and restrictions of each plan option available in your area. If you have a specific doctor or hospital that you want to use, be sure to check that they’re included in the network of the Medicare Advantage plan that you’re interested in.
You may also want to think about any medications you take. While many Medicare Advantage plans include prescription drug coverage, some do not. Whichever Medicare Advantage plan you choose, it’s important to check that it covers the prescriptions you need and compare the cost sharing because this may vary from plan to plan.
Do I qualify for enrollment in a Medicare Advantage plan?
Qualifying for enrollment in a Medicare Advantage plan requires that you are enrolled in both Medicare Part A and Part B. People with end-stage renal disease are generally not eligible to enroll in this type of Medicare plan. Additionally, you must live within the service area of the Medicare Advantage plan you’d like to enroll in.
So, is a Medicare Advantage plan right for you? And, should you get one with or without prescription drug coverage? The decision probably depends on your particular situation. I can work with you to get answers. Learn more about me by viewing my profile using the “View profile” link below. Or, use one of the links below to request a time to meet with me by phone or an email with personalized information for you. Compare the Medicare Advantage plans that you might be eligible for by clicking on the Compare Plans buttons on this page. Once you’ve taken a look, I or another eHealth licensed insurance agent can answer your remaining questions by phone–feel free to call us.
Call Medicare.com’s licensed insurance agents at 1-844-847-2659, TTY users 711; Monday through Friday, 8AM to 8PM ET.