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What is Medicare Advantage? Is It Bad?




Medicare Advantage (also known as Part C) is a different way to get your Medicare coverage through private insurance companies that offer plans following Medicare-enforced requirements and that usually bundle Parts A (hospital insurance), B (medical insurance), and D (prescription drug coverage).

The benefit to these Medicare Advantage Plans is that they can offer coverage for things Original Medicare doesn’t, “like fitness programs (like gym memberships or discounts) and sometimes routine vision, hearing, and dental services…For example, some plans may offer coverage for services like transportation to doctor visits, over-the-counter drugs, and services that promote your health and wellness.


Plans can also tailor their benefit packages to offer these benefits to certain chronically-ill enrollees.” Thus, it is important to consider your specific needs and evaluate if any Medicare Advantage Plans are already tailored to what you need.

For the most part, Medicare Advantage is a money-saving option for those in good health with infrequent and low-cost medical needs.


Those with more serious and frequent health needs that require expensive treatments and care often find Supplement Plans, also known as Medigap, are a better fit. In contrast to Medicare Advantage, which is an alternative way to get your Original Medicare coverage, Supplement Plans cover your out-of-pocket costs still leftover after Original Medicare. (Note: You cannot have both Medicare Advantage AND Supplement Plans.)

Are There Disadvantages to Medicare Advantage?


One issue some people have with Medicare Advantage is that your plan may limit your healthcare providers to those who are “in-network” for them (Source). This can limit your options, especially for people who want to stay with their same providers they had before enrolling in Medicare. Medicare Advantage, unlike Original Medicare, also requires prior authorizations for some services and may require referrals to see specialists (depending on the type of plan selected and the private-insurer’s policies). Many people, however, are used to this as they have the same restrictions on their employer plans or ACA (Obamacare plans).


Proponents of Original Medicare prefer that it does not have those limitations. Sometimes this is personal preference, and sometimes it is because of particular medical conditions that would require more hoops to jump through with Medicare Advantage. Those who prefer Original Medicare like that the doctor can really be in charge of a person’s healthcare without being at the mercy of an insurance company approving or denying coverage for a test or procedure.

Conclusion


It’s important to know the facts about both options- Medicare Advantage and Original Medicare- as one is not better or worse innately. They are different and each better serves different populations.

We’ve often worked with clients who’ve been told Medicare Advantage is bad, but after some digging we’ve learned they’ve been hearing this assessment from Medicare Supplement salespeople who are too lazy to go through the extra annual compliance training to offer Medicare Advantage.


The truth is the federal government requires agents to take an annual test (and they must pass within 3 tries 90% or higher) and then must take additional training and certification with every insurance carrier they want to represent. Thus, it’s important to get unbiased education when preparing to enroll in Medicare. That is one way we are different here at “Your Local Medicare Help”. We represent not only the TOP Medigap carriers but the TOP National AND Local MAPD carriers like HAP, Blue Cross, Priority Health, United Healthcare, Humana, Aetna, Wellcare, and more!


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