Pros and Cons of Medicare Advantage

We’ve all seen Joe Namath, Tony Bennett, the late Alex Trebeck and even JB Smoove on TV promoting Medicare Advantage in late night TV.  The ads can be a bit cheesy, but the benefits promised, and the pricing is difficult to ignore.  The broad array of benefits covering dental, vision and hearing are very attractive and the price is hard to beat, especially on a fixed income.

Unfortunately, we’ve also seen families caught off guard by the limits of coverage while a senior loved one is hospitalized or in rehab and facing a discharge sooner than the family expected or hoped.  Like everything, Medicare Advantage has some advantages as well as its share of disadvantages.  So, what is Medicare Advantage and who is it good for?

Medicare Advantage is a type of health insurance plan offered by private companies that contract with Medicare to provide coverage to beneficiaries. Also known as Medicare Part C, it combines the benefits of Original Medicare (Part A and Part B) with additional benefits such as prescription drug coverage, dental, vision, and hearing services, and wellness programs.

Advantages of Medicare Advantage

1. More comprehensive coverage: Medicare Advantage plans often offer additional benefits that aren’t covered by Original Medicare, such as dental, vision, and hearing services. Some plans also include prescription drug coverage, which can be a significant cost-saving benefit.
2. Out-of-pocket cost predictability: With a Medicare Advantage plan, beneficiaries pay a monthly premium in addition to any deductibles and copayments. This makes it easier to budget for healthcare expenses and avoid unexpected medical bills.
3. Access to care coordination: Medicare Advantage plans typically offer care coordination services, which can be helpful for individuals with chronic conditions or complex medical needs. Care coordinators can help beneficiaries manage their healthcare, schedule appointments, and access necessary services.
4. Annual out-of-pocket maximums: Medicare Advantage plans have an annual out-of-pocket maximum, which limits the amount beneficiaries have to pay for healthcare services each year. Once the out-of-pocket maximum is reached, the plan pays for all covered services for the rest of the year.

Disadvantages of Medicare Advantage

1. Limited provider networks: Medicare Advantage plans often have limited provider networks, which means beneficiaries may not be able to see the doctor or specialist they want. If a beneficiary sees an out-of-network provider, they may have to pay higher out-of-pocket costs or the entire cost of the service.
2. Increased administrative burden: Medicare Advantage plans often require beneficiaries to get prior authorization for certain services or treatments, which can be time-consuming and frustrating. Additionally, beneficiaries may have to navigate complex rules and regulations when it comes to using their benefits.
3. Potential for higher out-of-pocket costs: While Medicare Advantage plans have an annual out-of-pocket maximum, beneficiaries may still end up paying more out of pocket than they would with Original Medicare. This is because Medicare Advantage plans often have higher copayments and deductibles.
4. Limited geographic coverage: Some Medicare Advantage plans are only available in certain geographic areas. This can be a disadvantage for beneficiaries who travel frequently or live in rural areas with limited healthcare options.

Medicare Advantage plans offer some advantages such as lower premiums, coverage of a broad array of services, out-of-pocket cost predictability, access to care coordination, and annual out-of-pocket maximums. However, they also come with disadvantages such as shorter covered stays in hospitals and rehabs, limited provider networks, increased administrative burden, potential for higher out-of-pocket costs, and limited geographic coverage.

It’s important for beneficiaries to carefully weigh the pros and cons of Medicare Advantage before enrolling in a plan, and to compare the costs and benefits of different plans to find the one that best meets their healthcare needs and budget.  If one is already enrolled it’s important to re-evaluate the coverage annually to ensure it’s still the right coverage for one’s current health status.

If you or a loved one is facing a sooner-than-expected discharge and need help finding short or long term care options for a senior loved one reach out to Oasis Senior Advisors (914.356.1901 – 475.619.4123).  We can also connect you with the resources you need to evaluate whether Medicare Advantage is the right insurance