With Medicare open enrollment underway, I want to share my thoughts—and my concerns—about Medicare Advantage plans. As you will see, I do not think Medicare Advantage plans are inherently bad, but it’s important to do some research to determine whether it is the best option for you.
Let’s begin with a definition. Medicare Advantage is a type of health plan offered by Medicare-approved private companies. In essence, Medicare pays a sponsor a fixed payment and the sponsor then pays for the health care expenses of enrollees.
The ‘advantages’ of Medicare Advantage plans can include lower monthly premiums, coverage for vision and dental, and easier coordination of services. In short, it’s like “one-stop shopping.” However, this convenience comes with potential problems, including:
- A limited provider network
- Potentially higher out-of-pocket costs for certain services
- Greater review (and potential denial) of services than traditional Medicare
- No choice of a separate drug plan to reduce drug costs
- Limited ability to switch back to traditional Medicare with Medigap
(This information was taken from a webinar hosted by the Center for Medicare Advocacy. You can learn much more about traditional Medicare and Medicare Advantage by watching a recording of the webinar here.)
In addition, it is vital to understand that millions of elders will lose their Medicare Advantage plans in 2025. This is due to the fact that certain provisions of the Affordable Care Act, such as prescription drug caps and lower base payments to providers, make Medicare Advantage plans less profitable to the private companies offering them.
Many elders opt for Medicare Advantage plans because they seem so easy and comprehensive (especially in their advertisements), but that doesn’t mean they’re the best choice for you. For help deciding whether you should switch to a traditional supplement and Part D plan and if so, which ones, make an appointment with the SHINE counselor at your local senior center. And of course, I am available to help any and every way I can.
Until next time, take care…
Alexis