What You Need to Know About Medicare Advantage Plans

Updated on July 11, 2017
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When my husband and I turned 65, we signed up for Medicare Advantage. After six months, we switched to Original Medicare.

When Medicare Advantage Plans first were introduced to the U.S. public, they were immensely popular because navigating the complexities of Original Medicare was difficult, whereas Advantage Plans were easier to use and less expensive.

In fact, some of them were actually free!

  • For a senior on a fixed income, this seemed to be a blessing, and for some that turned out to be the truth.
  • For others these plans have been nothing but trouble!

When my husband and I first turned 65, we signed up for one of these programs. However, after six months of continual problems with the plan and its administrators (and lots of further research into other Medicare Advantage plans), we quickly switched to Original Medicare and combined it with a supplemental policy..

This turned out to be one of the best decisions we have ever made because it has saved us more than half a million dollars in medical bills. Not only that, it has eliminated many hassles.

For people who are healthy, Medicare Advantage plans can work. Then again, what plan wouldn't work if people don't need to use it!

Make sure you don't fall into the Medicare Advantage trap.
Make sure you don't fall into the Medicare Advantage trap. | Source

What Is an Advantage Plan?

Advantage Plans are policies that are sold by private insurers and are subsidized by the U.S. government.

They are not the same as Medicare. However, they must provide everything that Original Medicare offers plus additional benefits, such as gym memberships or coverage for vision and hearing services.

To be able to buy an Advantage Plan, individuals must first have Medicare Part A and B. Once they sign up, they can choose from a large variety of plans, all of which include drug coverage.

Plans vary greatly in their benefits, prices, co-pays and deductibles—so choosing the one that works the best can be more complicated than it may seem.

This is just one of the things that can create problems for people who buy them.

Advantage Is Not Medicare or Medidgap

One of the biggest problems with these plans is that many people don’t understand them.

  • Some think they are Medicare policies.
  • Others assume they are Medigap supplements.

Both are wrong.

Other than being subsidized by the government, these plans have absolutely nothing to do with Medicare or Medigap other than the fact that you must be enrolled in Medicare A and B before you can sign up.

They are stand alone plans that can charge and change what they like, even in the middle of a policy year.

For this reason if a patient has a problem with

  • overcharges,
  • a doctor dropping out of his plan or
  • a plan dropping its coverage

he has little or no recourse.

Some Plans Don’t Pay

Those plans that people think are so terrific often are the same ones that doctors drop out of without notice because they either are very slow to pay or don’t reimburse at all.

For this reason, many people get nasty surprises when they visit their doctors.

I have sat in more than one office reading signs stating that physicians no longer were taking certain plans.

They don’t call patients to warn them, so it is only when they arrive for an appointment that they find out they’ll either have to pay cash to see the doctor or find care elsewhere.

Some plans don't pay, so patients get dropped by their doctors.
Some plans don't pay, so patients get dropped by their doctors. | Source

Access to Care Is Limited

Most Advantage Plans use networks that require patients to have referrals before will pay for their care.

This means that people have to visit to their “gate keeper” doctor to get a referral before they can see a specialist.

Furthermore, they may not be able to see the specialist they favor because the best ones usually do not take Advantage Plans.

In some cases, people may not be able to see specialists at all because many plans play games with referrals.

They run people in circles and often claim after the fact that no referral was ever given, which means that patients may have to pay out of pocket for a service that was supposed to be covered!

Companies do this because it saves them money, and patients give in because they are too old, sick or tired to fight for their rights.

Several years ago my own Advantage Plan tried to make me pay $1400 for an MRI that clearly was supposed to be covered. They even agreed that it was covered, yet they wouldn’t pay.

It took me six months and a call for help to a federal senator to get the matter resolved.

For reasons such as these, people in declining health often drop out of Advantage plans and go back to Original Medicare so that they can see the doctors they want to see and get the care they need.

Dropping Out Can Be a Problem

There are only certain times of the year when individuals can change from one Advantage plan to another or make the move to Original Medicare.

Thus, someone who needs to see a certain doctor or go to a specific hospital will not be able to do so if he needs to change plans but it’s not time to do so.

This can be a big problem if the issue is a serious one such as cancer or a major heart issue.

Make sure you understand the limitations of any Medicare Advantage policy you buy.

Know What’s in Your Plan

While it can be difficult to know whether a plan will stop paying or a doctor will leave it, taking the time to find out what’s in one you’re thinking of buying into can go a long way towards protecting your health and your finances.

Advantage Plans work well for people who are in good health because they don’t use them often and when they do, it’s usually only for minor issues.

However, as people age, many need more services. Many can be extremely costly.

For this reason it’s important for people to know the limitations of their policies.

  • Do they have a broad network of doctors, hospitals and pharmacies?
  • How long have they been in business?
  • Have they ever been fined by the government for providing poor services to patients?
  • How good is their coverage?
  • Do they pay for transplants and dialysis?
  • How much will you have to pay beyond your monthly premiums?

You can find the answers to these and similar questions in a company’s policies. An insurance agent can also provide them to you.

The Center for Medicare Advocacy is another good place for you to learn what you need to know.

Know what's in your policy so that you don't encounter problems.
Know what's in your policy so that you don't encounter problems. | Source

Buy a Plan for the Right Reasons

Health care is important, so you need to make sure that you don’t buy a policy just because it is cheaper to have or easier to set up.

If you watch the attached video, you'll learn some important information about Medicare Advantage Plans that will help you to decide whether buying one of them will work for you.

Your goal should always be to have good access to the best doctors and hospitals at a price you can afford, but understand that there is no free lunch.

If you pay less, you most likely will get less. You don't want to be caught in a situation where you need to get to the best specialist only to learn that he is not in your network.

When situations like this arise, patients lose. Sometimes they lose their lives!

Don’t be one of them.

Know what’s in a Medicare Advantage policy before you decide to buy one.

If you don’t like what you see, keep searching until you do.

Would you buy a Medicare Advantage Policy?

See results

This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

© 2017 Sondra Rochelle


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