Medicare Advantage Plans are the #1 most complained about aspect of health insurance in the entire country. Like anything, they have their pros and cons; however, Senior Benefit Group believes that they are not the best route to go and that the cons far outweigh any benefits. 

Generally, Advantage Plans are much cheaper than Medicare Supplements; some are even completely free. Because of their low cost, the individual will typically be required to meet very large deductibles and be subject to out of pockets including coinsurance and copays. Like Supplements, Medicare Advantage Plans are also sold by private insurance companies.

The plans also have network restrictions – HMOs, PPOs, etc. – meaning your doctor/hospital may not accept your insurance. If you need a specific procedure or surgery completed, you could be stuck paying thousands of dollars out of pocket if that operation needs to be done at a location that is “out of network.” If you move to a different state, or are away on vacation and need medical attention, your Advantage Plan will most likely not cover any of the costs because you are now out of their network area. Advantage Plans are typically NEVER recommended for individuals living in rural areas. It is also important to note that providers can join and leave a plan’s network anytime of the year. 

Even though providers can switch networks anytime, you are only able to switch your Medicare Advantage Plan once a year, during the Annual Enrollment Period (October 15 – December 7). This means that, if your main physician decides to leave the network in January, you will need to find a new doctor for the remainder of that year, until you can enroll in a new plan.

Last but not least, the worst thing about advantage plans is that the plans and coverages could potentially change every year. Advantage Plans can change the way they cover certain prescriptions, and even change the amount of copays and deductibles you need to pay, leaving members with a lot of extra expenses. Some plans will even decide to stop participating in Medicare altogether, forcing their members to seek different coverage elsewhere! The bad news is that, if you decide to switch back to Original Medicare and enroll in a Medicare Supplement, you may be ineligible due to your current health conditions.