Medicare ADvantage

Benefits of Medicare Advantage Plans

Offers More Benefits Than Original Medicare

Medicare Part C plans offer all the benefits covered by Original Medicare in addition to extra benefits that vary from plan to plan. Medicare Advantage plan bundles are customized healthcare plans to meet your medical needs. 

Most Medicare Advantage plans bundle hospital, medical, and Medicare Part D prescription drug coverage. Some plans have in-network providers you can visit to receive your care, which would ultimately lower your out-of-pocket costs compared to going to a provider outside of these specific networks. These benefits may include:

• Medicare Part D prescription drug coverage
• Hearing aids
• Dental care
• Vision care
• And more

However, this will typically depend on which type of Medicare Advantage plan you choose. For example, Special Needs Plans (SNPs) are required to provide prescription drug coverage.

Disadvantages of Medicare Advantage Plans

Cost Difference

When you sign up for a Medicare Advantage plan, you are adding at least one more premium to your monthly premium total costs. Before you can enroll in Medicare Advantage, you have to enroll in Medicare Parts A and B.

Most people do not have to pay anything for Medicare Part A, but Part B does have a premium. The premium rates are subject to change annually. The premiums associated with Medicare Advantage can vary greatly, and some plans will have a premium as low as $0.

The private insurer determines the premium for the plan, which can vary, but some plans may have a $0 premium. If your plan does not include prescription drug coverage and you want it, you must add Part D, a third premium.

Plan Limits

The second main disadvantage of Medicare Advantage is that it may limit your choices for a provider. To be considered a Medicare plan provider, your insurance should be accepted as Original Medicare.

Medicare Advantage plans also limit your maximum out-of-pocket expenses. The current maximum out-of-pocket rate in 2024 is $8,850, but this is the upper limit, and some plans will have a lower cap. These rates are subject to change. Please reach out to us to get the current rates.

Restricted Network

With Original Medicare, you can generally go to any doctor or hospital that accepts Medicare and receive the same level of benefits for Medicare-covered services. Medicare Advantage plans, as mentioned previously, can have in-network providers and may require their members to use these networks to get care and treatment. If you receive care outside of this network, your Medicare Advantage plan may not cover your medical expenses unless it is an emergency.

Some Plans Require Referrals

Some Medicare Advantage plans, such as Health Maintenance Organization (HMO) Plans, often require a referral from your primary care physician to see a specialist. They may also ask that you choose a primary care physician that is within their provider network.

Should you sign up for a Medicare Advantage plan?

When it comes to choosing the best Medicare plan, there is no one-size-fits-all solution. Medicare Advantage offers several benefits, such as multiple plan and coverage options.   Choosing between Medicare Advantage and Traditional or Original Medicare depends on the type of medical coverage that you need.

Speaking with a licensed Medicare professional before you make this choice is ideal. We are here to help you discover which plan works for your medical needs. Fill out the form below to speak with a licensed Medicare professional today to compare your options and learn about the coverage available at no charge to you.