Pros and Cons of Medicare Advantage Plans

Medicare Advantage or Medicare Part C allows people with Medicare Part A (hospital insurance) and Part B (medical insurance) to receive the benefits alternatively. Its offered by private insurance companies contracted with Medicare. It offers the same level of coverage as Original Medicare.

Below are some pros and cons to help one choose Medicare Advantage.

Pros of Medicare Advantage

Less Expensive

The premium for a Medicare Advantage plan is set by the insurer and can differ between different Medicare Advantage plans. The monthly premiums for some Medicare Advantage plans may be as low as $0.

A Medicare Advantage plan restricts the amount of money one has to spend out of pocket. Once the insured person has spent the maximum amount, they don’t have to pay anything for the rest of the year.

One Place for All Health and Prescription Drug Coverage

Prescription medication coverage and Original Medicare are typically combined in Medicare Advantage plans. Many also provide additional benefits like eye, dental, and hearing care. Working with one plan administrator is very convenient and straightforward.

Cons of Medicare Advantage

Limited Choice of Healthcare Providers

Medicare Advantage plans have a restricted network of providers. Visiting a provider outside the network means the plan will not cover the medical expenses.

Doctor Referrals Required

Medicare Advantage plans work to avoid the improper use of medical services. Prior approval may be required for hospital stays, home health care, medical supplies, and complicated treatments. Medicare Advantage plans might need a doctor’s referral to approve and pay for specialist services.

Different Medicare Advantage Plans

The following are the most common Medicare Advantage plans:

• Health Maintenance Organization (HMO): One receives coverage in the network, except for emergency care, out-of-area urgent care, and out-of-area dialysis. A referral is required for specialist visits.
• Preferred Provider Organization (PPO): Coverage available through a private Medicare-approved insurance company. One can save money by visiting the plan’s in-network providers.
• Private Fee-for-Service (PFFS) Plan: Offered by private Medicare-approved insurance companies. The plan determines how much a person will pay health care providers and other coverage.
• Special Needs Plan (SNP): For people with specific diseases and conditions. It’s aimed to provide coverage to people belonging to a certain group.