Medicare Advantage

What are the Pros and Cons of Medicare Advantage?

The Medicare program is divided into different parts: Original Medicare (Parts A and B), Medicare Advantage (Part C), Part D, and Medigap. 

Medicare beneficiaries purchase Medicare Advantage plans from private insurance providers that Medicare approves. Medicare Advantage plans combine the coverage from Original Medicare, in addition to other services. To enroll in Medicare Advantage, you must have Original Medicare and not be enrolled in Medigap. 

Let’s go over the pros and cons of Medicare Advantage plans to determine if it’s the right choice for you.

Benefits of Medicare Advantage Plans

One of the major advantages of Medicare Advantage plans is the out-of-pocket maximum. Under Original Medicare, there is no limit to the out-of-pocket expenses you can pay. This means people with serious health conditions or who need frequent healthcare services may have to pay high amounts as out-of-pocket costs. However, all Medicare Advantage plans have out-of-pocket limits. If you meet this limit, the Medicare Advantage plan will cover the costs for approved services for the rest of the year.

In 2022, the out-of-pocket limit for in-network services is $7,550. For out-of-network services, the limit is set at $11,300.

Another benefit of Medicare Advantage plans is the extra services they cover. All Medicare Advantage plans are generally required to cover at least the same services that Part A and Part B cover. In addition, they also cover extra benefits such as prescription drug coverage, routine vision, dental, and hearing. Other perks include transportation to doctor appointments, delivery services, etc.

It is also possible to get lower out-of-pocket costs under Medicare Advantage. In addition to combining coverage from Original Medicare, Part D, and other coverage into a single plan, many Medicare Advantage plans will have $0 monthly premiums.

Disadvantages of Medicare Advantage Plans

Many Medicare Advantage plans such as HMOs and PPOs have provider networks. This can be beneficial to some plan members, but for others, they would like more flexibility with where they can go to receive care and other services. If you are enrolled in such a plan, your coverage will be limited to the providers in the network. If you go out-of-network, you may pay more or cover all of your healthcare costs out-of-pocket.

Also, if you are enrolled in Medicare Advantage, you cannot purchase a Medicare Supplement plan. Medicare Supplements only help to pay for the out-of-pocket expenses from Original Medicare. 

Need Medicare Advantage? Give Us a Call!

For more information and help with Medicare Advantage, call us today at 316-260-3331.