Pros And Cons of Medicare Advantage Plans

By Ed Crowe | General Articles | 0 comment | 23 October, 2023 | 0

Pros And Cons Medicare Advantage

With the Annual Enrollment Period just around the corner, agents need to brush up on all kinds of knowledge and regulations to better serve their clients in the coming months. Let’s look at the pros and cons of Medicare Advantage plans. Here’s a quick breakdown of the benefits and drawbacks of choosing a Medicare Advantage plan:

Pros And Cons Medicare Advantage – Pros

Medicare Advantage plans (also known as Medicare Part C) typically have cheaper premiums than Original Medicare. This can be a good choice for beneficiaries who need lower monthly premiums or out-of-pocket costs.
Medicare Advantage plans typically include drug coverage. This is not the case with Original Medicare.
There is an in-network out-of-pocket maximum for plan holders, which means that a beneficiary will not pay more than $8,300 a year for healthcare.
Medicare Advantage plans often come with perks, such as some vision, hearing, and dental services that do not come with Original Medicare plans. In some cases, they even include gym membership stipends or preventative chiropractic care.

Pros And Cons Medicare Advantage – Cons

Because there is a network of healthcare providers for each Medicare Advantage plan, beneficiaries are limited to the providers that are in-network. This means that they can use only certain hospitals, providers, and services in their area.
There is an approval process for some services and prescriptions, like preauthorization on seeing in-network specialists. Many services do require referrals in order to be covered by the plan. Original Medicare does not include this restriction.
The network of providers may change throughout the beneficiary’s plan, which may lead to inconsistencies in their doctors and providers being covered.
Costs are based on how often the beneficiary sees a doctor. The monthly premiums in Medicare Advantage plans are low or even free. Co-pays, coinsurance, and deductibles contain most of the cost. This means that a health emergency or expensive medical care could cost the beneficiary more with a Medicare Advantage plan than with an Original Medicare plan.