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Are Most People Happy With Their Medicare Advantage Plans?

Updated: Oct 28, 2023


Are people happy with Medicare Advantage plans?

Medicare Advantage Plans are health insurance plans offered by private companies that contract with Medicare to provide Medicare Part A and Part B benefits. Over 26 million Medicare beneficiaries, or 43% of all people with Medicare, are enrolled in a Medicare Advantage Plan. With Medicare Advantage enrollment growing each year, understanding the key pros and cons of these plans can help you decide whether a Medicare Advantage Plan is right for you.


This article will outline the main advantages and disadvantages of Medicare Advantage Plans compared to Original Medicare. We'll cover plan costs, provider networks, prescription drug coverage, and more so you can weigh your options and choose the best Medicare coverage. Read on to learn the key factors to consider when evaluating Medicare Advantage.


What is Medicare Advantage?

Medicare Advantage, sometimes called Medicare Part C, allows private insurance companies to provide Medicare benefits to beneficiaries who enroll in their plans. Medicare Advantage Plans must cover everything that Original Medicare covers, including hospital and medical services in Medicare Part A and outpatient care in Medicare Part B.


However, Medicare Advantage Plans have flexibility in how they deliver these benefits. Many Medicare Advantage Plans also include prescription drug coverage and other extras like dental, hearing, and vision benefits.


When you join a Medicare Advantage Plan, you still have Medicare but your coverage is provided through the private plan rather than Original Medicare. Medicare pays a fixed fee per enrollee to the plan.


Pros of Medicare Advantage Plans

There are several potential advantages to enrolling in a Medicare Advantage Plan rather than sticking with Original Medicare:


Lower Costs

Many Medicare Advantage Plans have $0 monthly premiums or lower premiums than Medigap plans paired with Medicare Part B. Medicare Advantage Plans also have an annual limit on your out-of-pocket costs for Part A and Part B covered services. This provides financial protection compared to Original Medicare which has no out-of-pocket cap.


Extra Benefits

The majority of Medicare Advantage Plans include prescription drug coverage, with many also covering routine dental, vision, and hearing services. These extra benefits can reduce your health care costs throughout the year.


Coordinated Care

Medicare Advantage Plans often have provider networks, allowing for greater care coordination and management of chronic conditions. Having all coverage through one plan may also reduce paperwork and simplify the process of using your benefits.


Satisfaction Rates

Surveys show that over 90% of Medicare Advantage enrollees are satisfied with their coverage and the extra benefits and services their plans provide. Many enrollees say Medicare Advantage Plans meet their healthcare needs well.


Cons of Medicare Advantage Plans

However, Medicare Advantage Plans also have some potential drawbacks to consider:


Provider Networks

Most Medicare Advantage Plans have provider networks, which means you may need to use in-network doctors, hospitals, and other facilities to get the highest level of coverage. This could limit your healthcare choices or require you to switch providers. Out-of-network care is often not covered except in emergencies.


Prior Authorization

Medicare Advantage Plans may require prior authorization from the plan before getting certain services. This process can delay care in some cases compared to Original Medicare which doesn't require authorization for services.


Premiums and Copays

While many Medicare Advantage Plans have $0 premiums, they often have copays or coinsurance for certain services. These out-of-pocket costs at the point of care may add up depending on your healthcare needs.


Drug Formularies

Medicare Advantage Plans with prescription drug coverage often have formularies or lists of covered medications. Your specific prescription drugs may not always be covered on a plan's formulary.


Limited Plan Choices

The specific Medicare Advantage Plans available depend on where you live. Rural counties may only have one or two plans to choose from, reducing your options.


Can't Use Medigap

If you join a Medicare Advantage Plan, you can't purchase a Medigap policy to cover cost-sharing in Medicare Parts A and B. This means you won't have supplemental coverage unless your Medicare Advantage Plan offers it.


Key Medicare Advantage Enrollment Considerations

When deciding whether to enroll in a Medicare Advantage Plan, here are some important factors to consider:

  • Will your current healthcare providers accept the plan's coverage? Check if your doctors are in-network and whether referrals are required to see specialists.

  • Do the plan's drug formulary and pharmacy network include your prescription medications and preferred pharmacy? Make sure your prescription costs will be covered.

  • How do the plan's estimated out-of-pocket costs compare to original Medicare? Consider premiums, deductibles, copays and the out-of-pocket maximum.

  • Does the plan include dental, hearing, vision and other benefits you may want? Compare extra benefits to your expected healthcare needs.

  • How does supplemental coverage compare between Medigap policies and what is offered by the Medicare Advantage Plan? This can affect your total costs.

  • Can you see out-of-network providers if needed? Some plans offer this flexibility while others do not.

Considering these factors will help you determine if the advantages of Medicare Advantage Plans outweigh the disadvantages in your situation.


Should You Choose Medicare Advantage or Original Medicare?

There is no one-size-fits-all answer to which option is better, Medicare Advantage or Original Medicare. The right choice comes down to your individual healthcare preferences, budget, and needs:


Medicare Advantage Plans tend to be a better option if you:

  • Want all-in-one coverage including medical, hospital, and usually drug benefits

  • Prefer paying low or no premiums in exchange for potentially higher copays

  • Don't mind provider networks and coordinating your care through a plan

  • Appreciate extra benefits like dental and vision coverage

Original Medicare tends to be a better option if you:

  • Don't want to be restricted to plan provider networks and referrals

  • Take expensive prescription drugs not covered on plan formularies

  • Have Medigap to supplement Medicare and minimize out-of-pocket costs

  • Prefer the open access to providers that comes with traditional Medicare

No matter which path you choose for your Medicare coverage, make sure to review your options thoroughly during open enrollment each year. Medicare Advantage Plans and Medigap policies have an annual enrollment period from October 15 to December 7.


The Bottom Line on Medicare Advantage Plans

Medicare Advantage Plans offer benefits like capped out-of-pocket spending, prescription drug coverage, coordinated care, and extra benefits that make them an attractive option for many Medicare beneficiaries. But limitations like provider networks and drug formularies may be disadvantageous for some.


Consider your personal health profile, finances, and provider preferences to determine if a Medicare Advantage Plan is your best Medicare coverage option. Medicare Advantage continues to evolve and offer expanded benefits to meet the diverse needs of the Medicare population. Reviewing your choices annually ensures you have health coverage that provides appropriate access, affordability, and quality of care.


We’re Here to Help

You do not have to spend hours reading articles on the internet to get answers to your Medicare questions. Give the licensed insurance agents at Lane Financial Strategies a Call at (804) 897-2170. You will get the answers you seek in a matter of minutes, with no pressure and no sales pitch. We are truly here to help.


FAQs


Are most people happy with their Medicare Advantage Plans?

The satisfaction levels of Medicare Advantage Plan members vary. While some people are satisfied with their coverage, others may not be. It is important to carefully evaluate your options and choose a plan that meets your specific healthcare needs.


What is Medicare coverage?

Medicare coverage refers to the healthcare services and supplies that are covered under the traditional Medicare beneficiaries program. This includes hospital stays, doctor visits, preventive care, and prescription drugs.


What are the pros and cons of Medicare?

Medicare has several advantages, such as providing comprehensive coverage for healthcare services. However, it also has limitations, such as high out-of-pocket costs and limited coverage for certain services.


Are people satisfied with their coverage?

Satisfaction with Medicare coverage can vary among individuals. While some people are satisfied with the benefits and services provided by Medicare, others may have concerns or may not feel adequately covered.


Should I enroll in a Medicare Advantage Plan or a Medicare Plan?

The decision to enroll in a Medicare and Medicare Advantage Plan depends on your individual healthcare needs. Medicare Advantage Plans offer additional benefits and may have lower out-of-pocket costs, but they also have a more limited network of providers.


How many Medicare Advantage Plans are there?

There is a wide variety of Medicare Advantage Plans available, with options varying by geographic location. The number of plans can change each year, so it's important to review your options annually.


What does Medicare Advantage coverage include?

Medicare Advantage coverage typically includes all the benefits of Medicare Part A and Part B, as well as additional benefits such as prescription drug coverage, dental, vision, and hearing care.


How do I enroll in Medicare Advantage?

To enroll in Medicare Advantage, you must first be eligible for Medicare. You can then choose a Medicare Advantage Plan through the Medicare Plan Finder or by contacting a Medicare Advantage Plan directly.


Are people satisfied with their Medicare Advantage Plans?

Satisfaction levels with Medicare Advantage Plans can vary. Some people are satisfied with the additional benefits and lower costs offered by Medicare Advantage Plans, while others may have concerns about the plan's network of providers or restrictions on coverage.


Can I choose a prescription drug plan if I am enrolled in Medicare Advantage?

Yes, you can choose a separate prescription drug plan if you are enrolled in Medicare Advantage. These plans are known as Medicare Part D Plans and can provide coverage for prescription medications.





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