Are Medicare Advantage plans a bad choice?

Are Medicare Advantage plans a bad choice?

You may often hear in your surroundings that Medicare Advantage Plans are bad and have more disadvantages than Original Medicare coverage. But, that doesn’t need to be necessarily true. The truth is that Medicare Advantage Plans are often misunderstood and aren’t the best fit for every Medicare beneficiary.

People often hear that MA plans have zero low premiums and offer basic coverage plus additional benefits like vision, dental, hearing, and drug prescription, but they also don’t get enough details and information before enrolling so it leaves them unsatisfied.

Common Mistakes of Medicare Advantage Plans

Common mistakes about MA Plans could happen because of a lack of information on what kind of service these plans provide for policyholders. If you purchase some of these plans because they sound attractive, without talking to an experienced Medicare broker like here in Missouri Insurance Advisors some crucial things may slip out. So, let’s talk about the most common mistakes in MA Plans.

Medicare Advantage Plans aren’t free

The first common mistake about Medicare Advantage Plans for quite several Medicare beneficiaries is that those plans are free. But, that isn’t true. When you choose the Medicare Advantage plan it becomes your primary source of coverage instead of the Original Medicare but they are also paid by Medicare itself. Private insurance companies sell MA plans which means that Medicare pays them to take on your health risk, but your provider still can charge you for every provided service.

Indeed, most companies don’t charge you anything for monthly premiums but you are still responsible for Medicare Part B premium. Also, Medicare Advantage plans work on a cost-sharing system which means that it covers 80% of services so you are responsible for covering the other 20% just like with the Original Medicare. You will also be responsible for out-of-pocket costs like copays and coinsurance for hospital visits to see a specialist or even 10$ or 20$ buck for primary care doctor visits.

To avoid this kind of mistake before enrolling you should look at the summary list of benefits that every plan provides and look at the costs for specific services (which you’ll need most often, to calculate your costs). 

Medicare Advantage Plans have limited doctor network coverage

The second most common mistake about Medicare Advantage plans is that doctor network coverage is wide. That is not entirely true, tough. MA Plans have limited doctor network coverage, sometimes just in your living area or in a few counties (often local or regional) which can leave you with only a few thousand provider options. Some of the Medicare beneficiaries don’t realize that before enrolling in Medicare Advantage Plans they think that you can go to any doctor you want. The truth is that you can only go to a doctor within your plan’s network, which means that the doctor needs to accept the terms of your MA Plan. They can easily turn you down if they don’t accept this type of coverage.

Before you decide to enroll it is good to check your provider’s doctor network, to avoid this inconvenience. That also depends on which MA plan you want to purchase, so it is smart to check the provider’s network for the exact plan you want to enroll in.

Besides that, some of the Medicare Advantage plans, like the HMO plan, require choosing a primary care physician to get referrals, so if you don’t like that condition, look carefully at what each plan has to offer before purchasing.

Medicare Advantage Plans are changeable 

One inconvenient fact with the Medicare Advantage plans is that their terms and conditions can change every year. This means that they can change the cost of premiums, copays, coinsurance, and deductibles. It also can change providers’ networks and pharmacy networks such as medication on the plans drug formulary. 

With this in mind, you want to analyze what has changed in your plan (you get the letter of changes a few months before the new calendar year), and if you don’t like the changes you can choose a different plan that is more convenient to your needs. You can do the transfer during the Medicare Advantage Enrollment period which happens between the 15th of October and to 7th of December. 

All Medicare Advantage Plans have Maximum Out-Of-The-Pocket Limits

Each Medicare Advantage Plan has its maximum out-of-pocket limit costs. This limit protects you in a way that when you reach this annual limit your plan must cover the rest of the costs. But, MOOP can go as high as 7500$ a year for medical services. How much you are going to spend depends on what your healthcare needs are. You need to pay 20% of coinsurance for several medicare services like durable medical equipment, dialysis, chemotherapy, and some drugs that are offered by Part B. Those costs can be very expensive, so you can have a large number of costs in a short period. So, if you need a lot of medical services and you don’t have that much money to spend every year, you might need to consider a Medicare Supplemental plan instead to avoid these costs.

Medicare Advantage plans can request prior authorizations 

Medicare Advantage Plans are, as already said, sold by private insurance companies. Those companies want to be sure that service is medically necessary before it is provided to you.

This means that they can require from your provider prior authorizations for some medical services before you get that kind of coverage as a patient. Sometimes, it can last days or even weeks to wait for approval and your service request can be denied if they decide that treatment isn’t medically necessary. If you think this could annoy you Medicare Advantage plan might be the right option for you.


Medicare Advantage plans aren’t for everyone, but they are not bad plans. Some beneficiaries will have advantages from purchasing those plans instead of some other plans. But, before choosing what is right for you, it crucial is to read the terms and conditions of the plan such as costs and benefits very carefully to avoid those mentioned common mistakes. If you are very well informed about the benefits and costs of each plan you can’t be left disappointed.

When it comes to this, and you aren’t sure if Medicare Advantage plans are fit for you talk with the experienced Medicare agent from Missouri Insurance Advisors. Our agents are well informed and they can provide you with any kind of information you may need. You are not alone in this. Contact us today and we will help to find you the best plan that fits your needs!

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