Whether you’re thinking about signing up for a Medicare Advantage plan or you have already signed up, it’s important to understand the pros and cons of it so that you can make an informed decision. Fortunately, there’s a lot of information out there on the web to help you make an educated decision.
Geographic Restrictions
Using a Medicare Advantage plan as the launching pad for a family vacation to Vegas has its advantages but it can be a pricey proposition if you are not careful. The most notable drawback is that the average American has to pay more for travel than they did in the olden days. Luckily, there are a number of affordable and convenient alternatives in the aforementioned state of Nevada.
The best part is that your local provider may offer a competitive edge on your travels. A good example of this is Medicare’s popular HealthReference.com program, which lets you search the database for thousands of health providers in your area. The website also has a user-friendly interface for the self-employed, which allows you to get a quote in minutes.
Out-of-Pocket Costs
Unlike traditional Medicare, Medicare Advantage plans may have limits on out-of-pocket costs. However, out-of-pocket costs are usually higher for out-of-network providers. This is a potential disadvantage of Medicare Advantage plans.
For example, Medicare Advantage plan beneficiaries are expected to pay an average of $749 for a three-day inpatient stay in 2022. This is higher than the $1,556 out-of-pocket maximum for traditional Medicare for a similar stay.
Cost-sharing plans that exceed the Part A deductible may have an average cost-sharing of $3,180. These plans have deductibles, copayments, and other out-of-pocket expenses that are not covered by traditional Medicare.
Medicare Advantage plans may also have an in-network cap. For example, plans may have a cap on the number of days you can have an in-network copayment. You can choose to use an out-of-network provider if you prefer. However, out-of-network providers may choose not to take your plan, or they may choose to treat you on a case-by-case basis.
Premiums
Depending on where you live, Medicare Advantage premiums can be quite low. However, they may also come with hefty copayments on doctor visits and prescription drugs.
In addition, you may have to pay more out-of-pocket expenses in the future, especially if your Medicare Advantage plan does not cap your expenses. That’s because the federal government has announced a cap on Medicare Advantage out-of-pocket costs. The new limit is $8,300 in 2023.
Medicare Advantage plans may include supplemental insurance such as Part D. The premium for Part D may increase in the future. You can compare costs and coverage options with Medicare’s plan finder. You can also check out Medicare’s prescription drug cost comparison tool.
Another option for Medicare beneficiaries is to use the Medicare Savings Programs. The programs are made available by the Centers for Medicare and Medicaid Services. These programs allow individuals with limited income to pay for their Medicare Advantage premiums.
Requirements
Whether you’re new to Medicare or you’re just looking for a change, there are a few requirements for Medicare Advantage plans that you’ll need to know. You can find out more about these requirements and how they can affect you by talking to a Medicare expert.
Medicare Advantage plans are private companies that are approved by Medicare. These companies receive revenue from your premiums and use 85% of the money to provide you with health care. Unlike traditional Medicare, there are no income limits to qualify. However, you will still need to pay for some of your health care out of pocket. You can change your Medicare Advantage plan or enroll in a new one during the open enrollment period or during a Special Enrollment Period.
Disadvantages
Despite the fact that Medicare Advantage plans are more convenient than traditional Medicare, they also have some disadvantages. These disadvantages can be summed up into three categories: health plan costs, physician cost sharing, and out-of-pocket costs.
Medicare Advantage costs are primarily driven by healthcare services, which can be expensive. However, they are much lower than traditional Medicare. These plans also have benefits like dental care, vision care, gym memberships, and preventative care benefits.
Another disadvantage of Medicare Advantage is that you have to pay higher out-of-pocket costs if you receive treatment outside of the plan’s network. This can be very expensive for people with chronic health conditions. It can also make it difficult for patients to budget their health care costs.
Another disadvantage of Medicare Advantage is that many plans require prior authorization for certain tests and procedures. This may seem like an easy way to control costs, but it can lead to physical and financial harm.