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Are There Disadvantages to Medicare Advantage?

Medicare Advantage Plans, also known as Part C of Medicare, are available for purchase from private insurance companies that are approved by Medicare.  A Medicare Advantage plan must cover all benefits of original Medicare Parts A and B but usually much more. When you purchase a Medicare Advantage plan you get essentially an all in one plan.  

Instead of using Medicare as your primary coverage you are electing to use the private insurance company to cover you. Advantage plans will do all of this and can include prescription drug coverage all for usually low, and sometimes even no, premiums.  Sounds too good to be true right? Well I’m here to tell you nothing is life is free, even when you reach Medicare age.

First remember even though you are no longer using Medicare as your primary insurance you still must pay your Part B premium.  While it seems great that you can have a plan for little or no premium you must make sure you read the fine print. Advantage plans are certainly not bad plans but you need to be aware of the costs that typically come with it.  

Besides continuing to pay your Part B premium and also any premium the plan may charge, you will have other costs. Advantage plans come with copays. Sometimes large copays. You will usually have a copay for almost every service you receive, except some preventative services.  

grandfather with his grandchildFor primary doctors the copay is typically low, more for a specialist and progresses higher for Outpatient procedures, Inpatient hospital stays and the most for Part B drugs like chemotherapy treatments where you could pay 20% of the cost.

There is some protection offered here because Medicare mandates that plans set a Maximum out of Pocket for plan expenses and that can be as high as $6700 for 2019. That number does not include your prescription cost or premiums.

Some other items to be aware of with Medicare Advantage, which are usually offered as HMO or PPO plans, there could be networks and referrals.  You need to be sure to see that the network has the doctors you currently see but you also should consider that your needs could change in the future.  

If you want to see a particular specialist or surgeon, you could be denied. If you would like a plan and also want to have prescription drug coverage you will need to get it through the plan in most cases.  That means if the plan’s coverage does not cover your specific prescriptions you may have to change what you are taking because you cannot pick a separate Part D plan when you have Medicare Advantage.

All of this said I do believe that Medicare Advantage serves a purpose.  It is good coverage because any coverage is better than none, however it is up to you to either read through the plan completely or seek the assistance of a knowledgeable Insurance Broker to walk you through the benefits for different options.   

BGA Insurance Group works with companies that offer both Medicare Advantage plans as well as Medicare Supplements and we can help you find what plan would best suit your needs.

Greg Gudis – Co-Founder, Licensed Medicare Agent

Greg Gudis BGA Insurance