Every single day, an estimated 10,000 baby boomers turn 65 and become eligible for Medicare plans, a federal health insurance program that provides inpatient and outpatient medical care. While many older adults choose Original Medicare for their insurance needs, about 34% choose a Medicare Advantage plan.

Unlike Original Medicare — provided by the federal government with equal benefits to all members at the same cost — Medicare Advantage plans are provided by private health insurance companies approved by Medicare and provide varying benefits, copays, and premiums. 

To get the best health insurance coverage, you should examine the pros and cons of Medicare plans. And while the Medicare Advantage plan offers extra benefits compared to the Original Medicare, it is necessary to examine its pros and cons.

In this article, we’ll summarize some of the advantages and disadvantages associated with Medicare Advantage plans.

Advantages of Medicare Advantage Plan

While Original Medicare helps cover primarily expenses, it may not cover everything. Therefore, Medicare beneficiaries have to opt for the Medicare Advantage program for additional coverage that Original Medicare does not provide.

In addition, many Medicare programs offer vision, hearing, dental, prescription drug therapy, and/or health and wellness programs, making it an attractive program for everyone. If you’re planning to choose Medicare Advantage for your needs, consider the following benefits of the program.

1. Affordability: For healthy baby boomers with minor health concerns, the premiums, copays, and deductibles required for Medicare Advantage plans are much cheaper. 

Although all Medicare beneficiaries have to pay the Part B premium whether they are enrolled in Original Medicare or Medicare Advantage, many Medicare Advantage plans have no additional premiums and may have lower deductibles and copays.

2. Coordination of Benefits: Seniors who have separate health insurance plans for vision, dental prescription, long-term care, and medical care have not only multiple plans but also various copays, premiums, and deductibles to track. Comprehensive Medicare Advantage plans provide streamlined coverage, making it easy for members to pay monthly premiums, submit claims, remember copies and deductibles, and track total out-of-pocket expenses.

3. Fitness benefits: A Medicare Advantage plan can also cover essential fitness services through a program that gives seniors (of 65+ age) unlimited access to 1000+ fitness locations across the country.

4. Card Consolidation: Medicare Advantage is generally considered an all-in-one program. With one card, you can avail medical, hospital, and prescription benefits. So, instead of carrying three separate cards for your Original Medicare benefits, supplemental insurance, and a prescription program (Part D)—you only need one.

5. Cheaper than a Medigap plan: Medicare supplemental insurance, also known as “Medigap,” is private health insurance that helps you pay for additional health care costs, such as copays, co-insurance, deductibles, and overseas. Medicare Advantage programs typically have lower premiums per month than Medigap programs.

6. Doctors and other providers are easily accessible: In some Medicare Advantage plans, network restrictions potentially limit your access to doctors and hospitals. However, if your doctors and providers are within your network and readily available to you, a Medicare Advantage plan may be an excellent choice.

Disadvantages of Medicare Advantage Plan

While Medicare Advantage plans have many advantages over Original Medicare, it still has a few drawbacks. Take a look at the cons as well before making a final decision.

1. Limited Service Areas

Unlike Original Medicare, the Medicare Advantage program opts for preferred provider networks. If a member goes to a health care provider outside of this network, they may end up with a lot of out-of-pocket money or coverage. An avid traveler must consider this factor as it may become a challenge for them.

2. Difficult to Compare Plans

Depending on where a Medicare-eligible baby boomer lives, they may have several Medicare Advantage plans available, each with its own unique options for coverage, provider network, drug formulas, and costs. As a result, it becomes difficult for seniors to compare plans and ensure they choose the most cost-effective option that best suits their needs.

3. Network Restrictions

Indeed, HMO or PPO’s network can streamline the communication between specialists and doctors, but it can also narrow your choices for professionals in that network.

Along these same lines, HMO Advantage programs require you to provide a primary care physician who can authorize specialist referrals. In contrast, PPO plans will often allow you to visit any doctor or hospital that accepts Medicare. 

No matter which Advantage program you choose (PPO or HMO), you should always have the latest information on doctors in your network, as they can change constantly. Comparatively, Original Medicare customers can find and meet with specialists on their own.

4. Potential Additional Advantage Plan Fees

We mentioned earlier that Advantage plans cover costs like deductibles, reimbursement, etc., on a single plan, whereas you will pay separately under Original Medicare.

However, some Advantage programs may come with additional costs that are no less than Original Medicare, such as drug deductibles and paid professional visits, which can add up over time and negatively impact the overall benefit you receive.

5. Authorization is Necessary Before Procedures

In most cases, as long as traditional Medicare covers a particular service or procedure, a person is not required to obtain authorization to receive treatment.

However, Medicare Advantage may require an individual to apply for authorization before the process to verify that the facility and the provider are in-network. While there may not be a delay in doing so, a person could end up waiting before they can get clearance for their procedure.

Many Medicare beneficiaries or seniors get confused with their needs, costs, and suitability if they sit to analyze each point. Simpler Horizons ensure that you don’t have to deal with any confusion, stress, or anxiety when choosing a Medicare Plan for you.

If you want to know whether Medicare Advantage will suit you, schedule a call with us, and our licensed Medicare agents will help you.