What Are the Advantages and Disadvantages of Medicare Advantage Plans?

By now, you’ve seen all the commercials and have gotten all the phone calls about Medicare Advantage plans. With all the hype, you might be wondering if the plans are as good as they make them sound. As with everything else in Medicare, the answer to that question is unique to every person.

We’re going to talk about the advantages and disadvantages of Medicare Advantage plans in Texas so you can decide if they’re a good fit for you.

The Advantages of Medicare Advantage

If you have seen the Medicare commercials, you’re aware of why Medicare Advantage plans are so attractive. But are the advertisements telling the truth? Yes! Well…kind of. The benefits you hear about in commercials are true. However, every Medicare Advantage plan is different, and you probably won’t find one plan that offers everything you saw on TV. Let’s take a closer look at all those bells and whistles.

Low Premiums. Yes, this one is absolutely an advantage! The average cost of a Medicare Advantage plan in Texas in 2023 is just under $9.00 per month. You can even find many plans for as little as $0. This is certainly an advantage when compared to Medicare Supplements, which range from $80 to $160 per month. Keep in mind, however, you’ll still be responsible for paying the Part B premium.

All-in-One Solution. When you enroll in a Medicare Advantage plan, all your benefits will be rolled into that plan. Instead of having to show your doctor a card for Medicare, a card for your supplement, your prescription card, your dental insurance, etc., all your coverage will be in one place. This does help lessen the confusion around which card is for what. Not to mention, your wallet will thank you!

Extra Benefits. Original Medicare (Parts A and B) with or without a Medicare Supplement only allows for certain benefits. In short, it offers inpatient and outpatient medical coverage. It does not cover prescription drugs, dental services, vision, or hearing care. Most Medicare Advantage plans include benefits for all these things. In addition, you’ll often get a few extra perks like transportation, meal delivery after a hospitalization, gym memberships, and a stipend for over-the-counter products. All these benefits are included in your plan’s premium.

The Disadvantages of Medicare Advantage

Of course, there are some downsides to Medicare Advantage plans in Texas. Don’t get swayed by all the benefits without considering the disadvantages. Some of these can make getting the care you need more difficult.

Provider Networks. Almost all Medicare Advantage plans operate on provider and facility networks. If you enroll in Company A’s plan, you’ll need to get care from providers who are contracted with Company A. Some plans do not have any coverage outside the network, while others offer coverage at a higher cost. Beneficiaries in rural areas may have a harder time accessing contracted providers.

Managed Care. Medicare Advantage plans are managed care plans, which is how they keep their costs low. The plan will dictate the treatment you receive. For example, your doctor might recommend one treatment, but the plan may require you to try a lower-costing alternative first. All-in-all, there are more rules to follow than you would have with Original Medicare.

Copayments/Coinsurance. The low monthly premium might sound great, but you should understand the copays or coinsurance costs outlined by the plan. Think of these plans as a “pay as you go” option. When you need treatment, there will almost always be costs involved.

How to Decide If Medicare Advantage Is Right for You

You might already know if Medicare Advantage is right for you. But if you’re still on the fence, there are a few questions you can ask yourself to aid your decision.

What is my budget? Medicare Supplement plans can get expensive, especially as you get older. It’s not uncommon for someone in their late-70s to be paying $300 a month just for their supplement plan. That doesn’t include the Part B premium, their Part D plan, or any other products like Dental/Vision/Hearing. On the other hand, can you afford the copays of a Medicare Advantage plan? Take a look at the plan’s maximum out-of-pocket. If the Advantage plan has a MOOP of $4,000, can you afford that in a worst-case scenario?

How is my health? Medicare Advantage plans work best for healthy people. If you rarely get sick or go to the doctor, you could save a lot of money in premiums by choosing Medicare Advantage. None of us knows what the future holds, but if you already have chronic conditions, Medicare Advantage might not be the best choice.

Still not sure? Call Cover Mile. Our independent insurance agents will take you on a deeper dive into your Medicare options and help you decide which plan is best for you. Call today to schedule a complimentary consultation.