Taking the Right Step: Why Medicare Advantage Plans DO NOT Always Give You An Advantage

By Jon Jordan

Want lower copayments and little to no deductibles? Enticing isn’t it? It’s the kind of promise that Medicare Advantage plans (HMO’s) offer. Oh yeah, I almost forgot you can even receive coverage for certain services and products that regular Medicare doesn’t cover, like certain prescription drugs. Are you hooked yet? Or does it sound too good to be true? Because if it does, well, you’re right, in many ways Medicare Advantage plans are too good to be true.

The big reason Medicare Advantage plans can make such promises is by severely limiting your choice of doctors and other health providers you can see. There is the possibility that your doctor who you have enjoyed going to for years may not be able to see you anymore because of the limitations laid out by Medicare Advantage plans. If you make use of a doctor or hospital NOT in the network, it’s important to remember neither the plan nor Medicare will pay. In short, you the patient, ends up footing the entire bill.

Ok, so maybe you are thinking, “well I will just find a Medicare Advantage plan that has my doctor.” Well, it might sound like the easy solution, but before you sign on the dotted line it is important to remember that it’s possible, in large part due to financial reasons, that your Medicare Advantage plan could drop your doctor from their network. So potentially your doctor, who was on your plan one day, could be dropped from your plan the next.

The concerns patients run into when using a Medicare Advantage plan don’t stop there. On a Medicare Advantage plan nearly every medical service you need must first be approved by your primary care physician. While that may not sound so bad at first, under your Advantage plan, the plans administrator could disagree with your physician that a type of medical service is required and simply choose not to pay for it.

Other key ways Medicare Advantage plans are able to reduce a lot of your upfront costs, is by limiting key medical services. For instance, the plans are known to shorten the time you can stay in a hospital or skilled nursing facility. Maybe you are one of the thousands of people today who are looking to stay in your home longer. Advantage plans can make that tougher too. Medicare Advantage plans are well known for providing fewer rehabilitative services such as home health care than what traditional Medicare beneficiaries receive.

So while you are trying to decide if a Medicare Advantage plan is right for you, the key thing to remember is cheaper doesn’t necessarily mean better.

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