Consumers and insurers love Medicare Advantage plans. The federal government has also benefited from private health insurance coverage for those 65 and older. But some Medicare experts warn against Medicare Advantage plans and encourage the use of Original Medicare.
Healthcare is a deeply personal decision, which is why it is important for people to reassess and compare their ever-evolving health care needs every enrollment period.
What is Medicare Advantage?
A Medicare Advantage Plan also called a Part C or an MA Plan may sound enticing. It combines Medicare Part A (hospital insurance), Medicare Part B (medical insurance), and usually Medicare Part D (prescription drug coverage) into one cohesive plan. These plans cover all Medicare services, and some offer extra coverage for vision, hearing, and dental. They are offered by private companies approved by Medicare.
Still, while many offer $0 premiums, the fine print is what gets you! You will find that most have unexpected out-of-pocket expenses when you get sick, and what they pay can differ depending upon your overall health.
Here’s a look at some of the disadvantages of Medicare Advantage Plans.
Consider potential premiums and other costs associated with unexpected healthcare expenses.
To see how a Medicare Advantage Plan cherry-picks its patients, carefully review the copays in the summary of benefits for every plan you are considering.
To give you an example of the types of copays you may find, here are some details of in-network services from a popular Humana Medicare Advantage Plan in Florida:
Hospital stay—$175 per day for the first 10 days
Diabetes supplies—average 20% copay
Diagnostic radiology—average $125 copay
Lab Services—average $100 copay
Outpatient x-rays—average $100 copay
Therapeutic radiology—$35/or an average of 20% (copay depending on the service)
Renal dialysis—20% of the cost
The costs add up! As this example demonstrates, out-of-pocket costs will quickly build up over the year if you get sick. The Medicare Advantage Plan may offer a $0 premium, but the out-of-pocket surprises may not be worth those initial savings if you get sick. “The best candidate for Medicare Advantage is someone who’s healthy,” says Mary Ashkar, senior attorney for the Center for Medicare Advocacy. “We see trouble when someone gets sick.”
“Medicare Advantage is a conspiracy on seniors because you pay more out-of-pocket than you ever will with a Medicare supplement,” said Ina Goldbergs with North Shore Insurance Brokers.
“People are going to take Medicare Advantage because on the surface it sounds good,” she added. “There’s going to be a major illness that will take away retirement income.”
Of those enrolled in an MA plan for 2021, 65 percent compared all of their Medicare options before enrolling, while 26 percent did a “brief amount of research.” Did you? Here are helpful resources on everything you need to know about your Medicare Advantage plan options.
Related Medicare Advantage Sources: