Medicare Advantage Plans - Advantages & Disadvantages

Medicare is a federal healthcare program for those over 65 or those with specific health conditions. When you qualify for Medicare you have two coverage options:

Original Medicare
Medicare Advantage Plans

Original Medicare includes Part A and Part B. Part A covers hospital care, while Part B covers physician and outpatient care. Medicare Advantage plans, on the other hand, cover both Part A and Part B as well as various other benefits. Think of it like Original Medicare being a cheese pizza, and Medicare Advantage being a deluxe pizza. A deluxe still has cheese, but there’s a lot of other toppings as well.

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Advantages of Medicare Advantage Plans

There are lots of reasons why a Medicare Advantage plan may be great for you. Here are some of them:

There’s 47 possible plans offered, so you are able to select the one that best suits your personal needs
Supplemental benefits offer more coverage than what is found in Original Medicare, they can include:
- Dental care
- Vision care
- Prescription drugs
- At-Home care
You have the option to receive coverage from a private insurer, allowing for a smoother transition out of your individual or employer-sponsored health insurance.
There’s an out-of-pocket maximum per year meaning that you will never need to spend more than that fixed amount on your health care in any given year (the amount is currently $6700).
It’s very convenient to have all of your benefits joined under one plan

Disadvantages of Medicare Advantage Plans

Though there are many positives to having a Medicare Advantage plan, there are also some negatives. They are as follows:

Some rural areas have less choice in Medicare Advantage plans
There’s a limited provider network, meaning that you are only covered for health care professionals that are certified by your insurance company. If you travel, or if your doctor switches out of the network you could be stuck with the cost
Benefits are subject to change annually, so what you had in your first year may not be what you have the year after that and so on
Certain types of Medicare Advantage plans, such as Health Maintenance Organizations (HMO), may require preauthorization and referrals from your doctor in order to seek treatment
The extensive coverage of Medicare Advantage plans are made possible through higher monthly premiums

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How to Know When Medicare Advantage Plans are Right for You?

It can be difficult to properly weigh all the advantages and disadvantages of Medicare Advantage plans in order to make a decision. Deciding on health insurance is a very personal matter and the choice deserves some serious consideration. The following are situations in which Medicare Advantage Plans are more likely to be suitable for your individual needs. If you

Live in a more urban area with lots plan options as well as in-network health care professionals
Are able to afford the monthly premiums
Are in moderately good health
Have health needs that are easily met by professionals within your network
Don’t plan on moving away from your current home State

then Medicare Advantage plans will work very well for you. Perhaps you are reading this and thinking that a Medicare Advantage Plan might not be the best choice for you, after all. But you still want to have more than just Part A and Part B coverage. Fortunately, there are ways to supplement Original Medicare coverage:

You can purchase Part D coverage that covers prescription drugs
You can purchase a separate policy for dental and vision care from a private insurance company
You can purchase Medigap coverage which is designed to fill in the gaps of Original Medicare

At the end of the day, the best decision is an informed decision. There is no harm in carefully considering all of your options before committing to a plan.

Margaret Huntley Margaret Huntley is a creative writing and philosophy student at Western University. She has been working as a freelance writer for over two years and has written about everything from insurance, to poker, to health and wellness for international businesses.