Why Medicare Advantage Plans Are Bad
- Original Medicare (Medicare Part A and Medicare Part B)
- Original Medicare (Medicare Part A and Part B) + Medigap Plan (Predictable Costs & Coverage)
- Medicare Advantage Plan HMO/PPO (Unpredictable Costs & Coverage)
It Boils Down To This:
Any time there’s confusion with insurance, then there’s a chance for unexpected costs and surprises.
What Are The Advantages And Disadvantages Of Medicare Advantage Plans?
Advantage plans have their place. The two biggest ways they can be helpful are with eligibility and affordability:
Medicare Advantage plans are a great safety net for anyone who isn’t eligible for a Medicare Supplement insurance plan. There are some people who enroll in a MAPD because of their health. Medicare beneficiaries who can’t qualify for a Medigap plan due to health reasons, then a MA plan is a good option. It’s definitely better than nothing so you’re not on the hook for Original Medicare’s 20% coinsurance.
That “Low or No Premium” Medicare Advantage plan may end up costing you THOUSANDS of dollars with the plan’s Maximum Out of Pocket at anytime.
- Prior Authorizations
- Frequent Expenses
- Out-of-Pocket Maximums
- Plan Changes
- Medicare is no longer managing your healthcare
- Want to see a cardiologist? You’ll need a referral.
- Want to see an orthopedic doctor? You’ll need a referral.
- How about an Endocrinologist? Get a referral
- Neurologist? Referral!
- You make an appointment with your primary physician.
- You get a referral to a specialist inside your network.
- You make another appointment to the specialist.
- You’re finally at the appointment to diagnose and treat your condition.
Copayments & Coinsurance
- Primary care physician visits
- A visit to a specialist
- Prescription drugs
- Eyeglass lenses
- Chiropractic coverage
- Emergency room visits
- Dental services
- Ambulance rides
- MRI or CT scans
- Days in a skilled nursing facility
- Outpatient surgeries
- Inpatient hospital days
- Outpatient rehabilitation
- And more
- Example: Your Medicare Advantage Plan has a MOOP of $8,000.
- Perhaps your cancer treatment happens in November and you reach your MOOP. However, you treatment needs to continue into January.
- Guess what? Your MOOP resets at the beginning of the calendar year.
- You are responsible for the first MOOP of $8,000 in November and a new MOOP of $8,000 beginning in January.
- You’ll be responsible for paying $16,000 in the span of a few months.
One of the biggest reasons why MAPD plans are bad is that your healthcare is managed by an insurance company. Meaning that the insurance company makes all of the decisions about your health care needs.
Frequently Asked Questions
There is no definitive answer to this question as different people have different opinions on what constitutes a "worst" Medicare Advantage plan. However, some factors that could make a Medicare Advantage plan less desirable include high premiums, high out-of-pocket costs, limited coverage, and poor customer service.
The worst Medicare Advantage plan is often any plan that is misunderstood. The simple truth is that MA plans can be very confusing and they change annually. However, if you fully understand everything about these plans, are comfortable with their unexpected costs and fine print, then it's possible to avoid the pitfalls of the plan.
- $300: Ambulance
- $175 Hospital stay per day for first 10 days
- Up to 20% co-pay for diabetic supplies
- Up to $125 co-pay for diagnostic radiology
- Up to $100 co-pay for lab services
- Up to $100 co-pay outpatient x-rays
- $35 or up to 20% co-pay depending on the therapeutic radiology service
- 20% of the cost of renal dialysis
Medicare advantage plans were created to offer beneficiaries an alternative to traditional Medicare coverage. These plans are offered by private insurance companies and sometimes include additional benefits not covered by traditional Medicare, such as dental and vision coverage.
Choosing a Medicare plan can be extremely confusing. It’s even more confusing when you mix in complicated plans such as Medigap or Medicare Advantage.
Just know that REMEDIGAP is here for you. We’re independent licensed brokers who shop the market for the best available plans. In other words, we’re your personal Medicare agent; we work for you and not the insurance companies. We have the freedom to focus on you and your Medicare coverage needs.