What is a Medicare advantage plan and should I get it?

Medicare is a private insurance plan. However, advantage plans are an alternative to private insurance. These plans are distinct from Medicare and have several pros and cons. 

Medicare Advantage plans may vary and can provide better care, flexible plans, and saving opportunities. On the other hand, some plans may be too expensive to afford, have fewer options to offer, and may require changes in your lifestyle. 

We will provide information on Medicare advantages in this article and also their procedure, advantages, and disadvantages so you can know whether they are suitable for you or not.

What is Medicare Advantage?

Medicare Advantage is an extension of Medicare’s original plans and is often known as Medicare Part C. Several private insurance companies offer these plans. The features of these plans are a combination of original plans (Part A and Part B) and with some modification and additional options, Part C is made. 

Most Medicare Advantage plans offer the following benefits:

  •  Hospitalization
  •  Hearing
  •  Some home healthcare services
  •  Vision
  •  Prescription drug coverage
  •  Hospice care
  •  Dental
  •  Doctor’s visits
  •  Preventive care

Types of Medicare Advantage plans

There are a variety of Medicare advantage plans that you can choose from depending upon your needs: 

  • Health Maintenance Organization (HMO). By opting for HMO plans, you will be provided in-network doctors for your service. However, for the appointment of doctors, you may need referrals.
  • Preferred Provider Organization (PPO). As opposed to HMO, PPO plans offer both in-network and out-of-network medical services but the cost for both of them is different. 
  • Private Fee-for-Service (PFFS). PFFS plans offer flexibility in terms of payment and can be designed depending upon your capability.
  • Special Needs Plans (SNPs). SNPs are designed for payment for chronic medical conditions and long-term. 
  • Medical Savings Account (MSA). MSA plans are opted in pair with costly health plans and help to save money from medical expenditures. 

Medicare Advantage Benefits 

Medicare advantage plans benefits and options are more than that of original Medicare plans. 

Convenient coverage options

Original Medicare plans offer limited coverage and options and you need to purchase other plans to cover additional expenditures. If you opt for Original Medicare, it will only provide hospital insurance and medical insurance. If your needs are not covered in these two coverage options, you will need Medicare Part D for covering the cost of prescription drugs and Medigap for supplemental coverage.

Contrary to Medicare plans, all your needs and additional coverage are covered in the Medicare Advantage plans.

Personalized plan structures

Medicare Advantage provides flexible plans for every distinct situation and needs. For example, as mentioned before HMO plans can offer in-network specialists and if you don’t prefer them you can opt for PPO plans and get your desired services. Similarly, the PFFS plan can also provide consumer freedom and lets you select your options freely. Apart from basic medical services, these plans also provide additional services like hearing, dental and preventive care, etc. 

Cost-saving opportunities

Most of the Advantage plans are quite affordable and offer little to no deductible cost and cover best services without purchasing premiums. If you can’t cover all your costs in these plans, you’ll have to pay out-of-pocket but Medicare Advantage plans set annual limits of such costs. Also, you can save more by opting Medicare Advantage plan in services like laboratory expenses and medical equipment. You’ll be able to see much more savings if you end up choosing a Medicare HMO plan. 

Coordinated medical care

Many Medicare Advantage plans have a coordinated care network. Your healthcare providers are constantly communicating to get you the best care possible through various healthcare services. The service provider does all the interactions for you and you can save the expenses of choosing a healthcare team and you can have a group of specialists ready at your disposal. According to researchers, this type of medical care results in better service for the patients which has been estimated by higher ratings and it also eases the work of medical staff and can avoid any unpleasant experiences.

Disadvantages of Medicare Advantage

With all the mentioned advantages of the Medicare Advantage plans, most of the people are quite content by choosing them. However, these plans also have some disadvantages which may trouble you. 

Limited service providers

If you opt for a Medicare Advantage plan instead of the original Medicare plans you may be limited to the health care providers. Such as HMO, it limits you to choose from only in-network specialists and you need to pay additionally if you plan to choose otherwise i.e out-of-network. Similarly, the plans, which do not pose such restrictions, are expensive and have high deductibles and copays. 

Complex plan offerings

Medicare provides a tool, find a plan, through which you can narrow down your search for plans. You’ll see that many Medicare Advantage plans limits their options in different ZIP codes. Some users might find it difficult not be able to access certain benefits due to different ZIP codes. 

Additional costs for coverage

Original Medicare plan only provides two coverage option and also have a high deductible, copays, and premium plans. In addition to this, you may need to pay for any Part D or Medigap for additional coverage.

Medicare Advantage plans provide a variety of options without these additional plans but their cost is more than Original Medicare plans. For example, many Medicare Advantage plans include drug deductibles and specialist visit copays.

State-specific coverage

Original Medicare’s services spread all across the United States. On the other hand, Medicare Advantage plans extend their special services in selected areas. So, if you are currently utilizing the Medicare Advantage plan, and you change your residence, your current plan may not be functional anymore.

The takeaway

As mentioned above, Medicare Advantage has many advantages over the Original Medicare plan such as better care, flexible plans, and saving opportunities. But these plans pose more restrictions, limit services and are more costly.


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