Many seniors love the ease that comes with a medicare advantage (Medicare Part C) plan. Rather than having to sift through all the different coverage options, medicare advantage plans combine both hospital (Medicare Part A) with medical insurance (Medicare Part B,) and usually include additional coverage for prescriptions, vision, hearing, and dental (Medicare Part D.) Best of all, Medicare Advantage plans can even have $0 monthly premiums. But not everything is all roses, there are some thorns in Medicare Advantage plans. We’ll go over some important disadvantages of Medicare Advantage plans that might make you second guess your choice.
Also Read: A Guide To All Medicare Coverage Plans (With Charts)
Why Do Medicare Advantage Plans Have $0 Premiums?
Private insurance companies partner with Medicare (a government-run agency) to create the “all-in-one” plan. Advantage plans receive subsidy funds from the Medicare payments over your lifetime, either through work or your Part B premiums. Since all these private companies need to compete for your business, premiums can be as low as $0, and they may even lower your Part B premiums.
On the other hand, just because something has a cheaper monthly rate doesn’t mean that you’re getting the best deal. Here are some disadvantages to a Medicare Advantage plan.
Also Read: Medicare Advantage Plan FAQ
Con: Limited Services
Most HMO plans with Medicare Advantage are very limited, especially with your medical providers. Expect much higher fees if you need to go out of network. Other Medicare Advantage plans have more provider coverage, but these plans have higher premiums and other additional fees.
Although these plans are meant to give “all-in-one” coverage by offering Parts A, B, and D combined, it doesn’t always stretch as far as you might need it to. Consider how often you may need to go out of network and how many medical providers you often seek.
Oftentimes, your Medicare Advantage plan options depend on your ZIP. Medicare Advantage providers discourage people with health issues from getting a Medicare Advantage plan. It’s often easier to purchase a combination of various Medicare plans.
Con: Additional Coverage Costs
Similar to an “all-in-one” shampoo and conditioner, Medicare Advantage may not cover a lot of specifics despite covering “everything”. Users often find a lot of additional fees for things such as drug deductibles and copays for specialist visits.
Before committing to a Medicare Advantage plan, carefully review the copay and deductible summary. On average, here are some expected copays you could see on your Advantage plan.
| Service | Estimated Copay Price |
| Hospital stay | $100 a day |
| Emergency room | $120 |
| Diagnostic radiology | $100 |
| Lab services | $50 |
| Outpatient x-rays | $50 |
| Outpatient surgery | $100 |
If you get sick or have an accident, your out-of-pocket costs can quickly add up. Despite the $0 monthly premium, beware of the out-of-pocket expenses.
Also Read: How Your Income Affects Your Medicare (2021)
Con: Plans Vary From State To State
Regular Medicare is universal across the United States. However, since Medicare Advantage plans are private plans, they vary depending on your state. For example, the above chart is specific to a plan in Florida.
As we mentioned earlier, Medicare Advantage plans vary depending on your ZIP. If you live in a rural area, you may not have the best network included in your plan. If you move to another state or even a different area, your Medicare Advantage plan may be unavailable. You can switch your plan outside of open enrollment, but the process can be quite tedious in many cases.
If you travel often, you may not receive coverage everywhere you visit. This is extremely challenging if you get hurt out of your home state.
Con: Unprecedented Illnesses
Whether you get cancer, diabetes, or contract a viral disease, your Medicare Advantage plan likely won’t cover everything. If you get sick halfway through the year, you’re stuck with your Medicare Advantage plan until open enrollment.
It’s always better to have more coverage than needed. As you age, there is a higher chance of you contracting an illness or sickness, and getting into an accident. If you want to hear some common coverage options, you can call Quote Purple at any time to talk to one of our partnered providers.
Con: Restrictive Plans
Medicare Advantage users often find their plans are quite limited in many ways they need to access their coverage.
Plans don’t stay the same forever. Medicare Advantage plans change all the time, which can really throw off your payments and treatment plans from year to year. Healthcare providers are often dropped from networks without cause, breaking your continued care. Since users are so restricted with their care, they often don’t get their first choice in healthcare providers.
The most frustrating part about the restrictive plans is users have difficulty getting emergency or urgent care. And despite the fact that these plans offer more additional benefits like vision, these benefits are extremely limited. For example, expensive prescription drugs have certain caps.
Also Read: How Diabetes Affects Your Health Insurance
Choosing the best Medicare Advantage plan for your needs can be complicated. There are many things to consider before you decide.
How To Choose The Right Medicare Advantage Plan
In many cases, despite some of the downsides, $0 monthly premiums are hard to say no to. When choosing your Medicare plan, ask yourself:
- How much did you spend on both fixed and out-of-pocket healthcare costs?
- Which prescriptions do you need and how expensive they are?
- What additional coverage (vision, dental, hearing) do you need?
- Will a chronic condition affect your plan, how often do you seek care for your condition?
- Do you have long-term medical needs or concerns?
- Does your current doctor fall under the same network?
- How important is it to receive your current physician’s continued care?
- How often do you seek care out-of-network?
Most importantly, when looking for Medicare Advantage plans, you should check CMS (The Centers for Medicare & Medicaid Services) quality star rating. The CMS star rating measures things like managing chronic conditions, available care, customer experience, and drug pricing.
If you’re ever confused about which plan is best suited for you, you can use an unbiased tool like Quote Purple to get a free quote and talk directly with a partner when you call today.
Also Read: Open Enrollment 2021: Changes You Need to Know About