Pros and Cons of Medicare Advantage (And Why Some Believe They’re Bad)

Jun 14, 2022 Medicare Advantage

Enrollment in Medicare Advantage is on the rise. In just last year alone, over 26 million Medicare beneficiaries enrolled in a MA plan, and over the last decade, enrollment has nearly doubled. Between the gaining popularity, the constant barrage of enticing advertisements, and the growing need for supplemental insurance, it’s no wonder why many Medicare-eligible individuals have questions and concerns about Medicare Advantage plans.

With all the buzz, it can be overwhelming to choose a supplemental insurance plan. The good news is that we are here to clear the confusion for you. Let’s take a look at why Medicare Advantage plans are enticing and why some question if and why Medicare Advantage plans are bad.

What is Medicare Advantage?

Before we dive into the pros and common concerns of Medicare Advantage, let’s first discuss what it is.

Medicare Advantage, also known as Part C or MA plans, is an alternative way for beneficiaries to receive their Original Medicare benefits. MA Plans are offered by private Medicare-approved insurance companies and cover all the same benefits as traditional Medicare (Part A and Part B) and may also include additional coverage benefits.

Why Medicare Advantage Plans are Popular

Many Medicare-eligible individuals are surprised to learn when enrolling in Original Medicare that it covers the basics but it doesn’t cover much. While Original Medicare does include hospital insurance (Part A) and medical insurance (Part B), it only covers about 80% of the cost leaving the beneficiary to cover the other 20%.

This gap in coverage can be extremely costly and can be financially devastating if an unexpected health emergency were to occur. Because of the gaps in coverage with Original Medicare, often Medicare-eligible individuals choose to enroll in supplemental insurance like a Medicare Advantage or Medicare Supplement plan. For a closer look at the differences between Medicare Advantage and Medicare Supplement visit our blog post: “Medicare Advantage vs Medigap: What’s the Difference?”

Here are a few reasons why Medicare Advantage plans are often the favorite:

Medicare Advantage Pros

Monthly premium will vary. Some plans may not include a deductible.
Combines Medicare Part A, B, and often Medicare Part D under one plan.
May include extra benefits not covered by Original Medicare.

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Common Medicare Advantage Concerns

If you watch TV or even listen to the radio you’ve most likely come across a dozen advertisements offering various premiums for Medicare Advantage plans with additional benefits. While these types of advertisements are certainly enticing, they can also be misleading. The oversell and misleading nature of these ads have left some individuals skeptical about Medicare Advantage plans. Just like with any plan, there are positives and negatives.

Let’s take a look at the common concerns some enrollees have with Medicare Advantage plans:

Disadvantages of Medicare Advantage Plans

There are costs associated with Medicare Advantage plans. Still have to pay Medicare Part B premium, copays, and coinsurance.
Limited to a network of doctors and hospitals. Coverage does not travel with you.
High out-of-pocket maximum ($7,550 for 2022).
Requires approvals for referrals.
Plan benefits change annually.

Choosing the Right Health Care Plan for You

Now that we’ve covered the pros and common concerns of Medicare Advantage plans and why some people believe they are bad, it is important to note that choosing a health care plan is not a one size fits all option. One individual’s positive may be another’s negative. The most important aspect of choosing health insurance coverage is understanding all the benefits and how they relate to your individual needs.

At AGA Medicare options, we help you sift through the noise and clear the confusion of choosing a Medicare plan. Our Independent Insurance Agents are well versed in all Medicare options, not just one, and will walk you through all plan details to ensure you are confident with your choice.