What are the Pros and Cons of Medicare Advantage Plans?

What are the Pros and Cons of Medicare Advantage Plans?

You may ask if enrolling in a Medicare Advantage plan or Original Medicare is preferable. There is no straightforward answer because Medicare Advantage solutions provide crucial advantages that many individuals find appealing and other aspects that may not match your specific tastes and lifestyle. Take a deeper look at some of the key benefits and drawbacks of Medicare Advantage plans. Here, in this article you know the pros and cons of Medicare Advantage plans.

What is the Medicare Advantage plan, and what does it cover?

Medicare Advantage, commonly known as Medicare Part C, allows persons with Medicare Parts A and B (hospital and medical insurance) to get their Medicare benefits differently. Private insurance firms contracted with Medicare provide Medicare Advantage solutions, which give at least the same level of coverage as Original Medicare.

How Medicare Advantage Plans Function

First, let’s go over some fundamentals. Medicare is divided into four components, the first of which covers inpatient hospital care and skilled nursing. There is no premium if you or your spouse have earned at least 40 Social Security credits.

Part B covers medical visits and outpatient hospitalization. This plan requires a monthly premium of $170.10 in 2022, with a deductible of $233. High-income earners pay more.

Part C, called Medicare Advantage, and Part D, prescription medication coverage, are voluntary and provided by commercial insurers.

Medicare Advantage solutions frequently give more benefits than Original Medicare.

Medicare Advantage plans must provide at least the same level of coverage as Medicare Parts A and B, and many programs also include additional benefits. These may include routine vision care, hearing aids, routine dental care, prescription medication coverage, and membership in a fitness center.

Pros of Medicare Advantage Plans

  1. Medicare Advantage Plans May Be Less Expensive

You must continue to pay your Medicare Part B payments if you join a Medicare Advantage plan and may be required to pay an extra premium. The insurer sets the tip for the Medicare Advantage plan, which might differ from one Medicare Advantage plan to the next. Monthly premiums for specific Medicare Advantage plans may be as low as $0.

Medicare Advantage solutions may also reduce your cost sharing. For example, if a Medicare Advantage enrollee visits a primary care physician, they may be required to pay a copayment of $10. If the enrollee visits a primary care physician under Original Medicare, they may be subject to a 20% coinsurance, which may be more than $10.

2. Medicare Advantage programs help your health care professionals coordinate care.

Medicare Advantage plans are managed care plans with networks of contracted health care providers. Health Maintenance Organization (HMO) Medicare Advantage plans are one example. Most HMO plans require subscribers to choose a Primary Treatment Physician (PCP) who will assist them in coordinating their care.

Medication therapy management may be available in Medicare Advantage plans, including Medicare prescription drug coverage. This care coordination may be both convenient and beneficial to your health.

3. Medicare Advantage plans can act as a “one-stop shop” for all of your health and prescription medication coverage requirements.

Most Medicare Advantage plans include both Original Medicare and prescription medication coverage. Many organizations also organize the delivery of supplemental benefits such as vision, dental, and hearing care. Working with a single plan administrator may be more convenient for you.

The Cons of Medicare Advantage Plans

  1. Medicare Advantage programs may limit your options for healthcare providers.

In principle, enrollees in the federally controlled Medicare program can go to any doctor or facility that accepts Medicare and get the same Medicare benefits for eligible treatments. 

2. Some treatments and procedures covered by Medicare Advantage plans may need a doctor’s referral and planning permission.

Through different techniques, Medicare Advantage solutions attempt to avoid the misuse or overuse of health services. Medicare Advantage plans may also demand a recommendation from your primary care doctor before they would pay for treatments.

3. Most Medicare Advantage plans have regional networks of participating providers rather than countrywide networks.        To enroll, you must spend at least 6 months of the year in the Medicare Advantage plan’s coverage region. This criterion may be difficult to achieve if you spend time between houses in various locations.


The ultimate line is that Medicare Advantage plans may provide more economical coverage than traditional Medicare plans. To get reimbursement for approved treatments, you must follow the regulations of your Medicare Advantage plan.

Simpler Horizons is known to be one of the best Medicare Advantage agencies; let us help you choose the right and perfect Medicare plan for you!

Do you have any other questions regarding Medicare Advantage? Call us to talk with a professional insurance agent about Medicare Advantage plans in your region and your Medicare coverage alternatives.