Pros And Cons Of Affordable Medicare Advantage Plan

Introduction

Affordable Medicare Advantage plans, also called Medicare Part C plans, operate as private health plans within the Medicare program, serving as coverage alternatives to Original Medicare. In many cases, Affordable Medicare Advantage plans provide more services at a cost that is the same or cheaper than the Original Medicare program.

Advantages of Affordable Medicare Advantage

There may be advantages if you choose a Medicare Advantage plan compared to the original Medicare.

Affordable Medicare Advantages for personalized plan structures

Medicare Advantage offers different plan types for your situation. For example, an SNP Advantage plan can help with your medical costs if you have a chronic health condition.
If you prefer provider freedom, a PPO or PFFS plan may be more of what you’re looking for. Many Medicare Advantage plans include if you want extra services like dental, vision, or hearing.

Cost-saving opportunities

Many Affordable Medicare Advantage have no premiums and offer low or no deductibles. Another advantage of choosing Medicare Advantage is that most plans limit the maximum out-of-pocket costs you will pay during a plan year.

Also, researchTrusted Source has shown that you may save money on laboratory services and medical equipment by switching to a Medicare Advantage plan. If you choose a Medicare HMO plan, you may see even more savings on healthcare services provided by your HMO network.

Coordinated medical care

Many Affordable Medicare Advantage plans include coordinated medical care. This means that your healthcare providers actively communicate to coordinate your care in two different types:

healthcare services
medical specialties

This ensures a healthcare team and helps avoid unnecessary expenses and issues like medication interactions. In one study, trusted Source, researchers found that coordinated care was associated with higher patient ratings and more positive medical staff experiences.

Disadvantages of Affordable Medicare Advantages

While most people are satisfied with their Medicare Advantage coverage, these plans may also have some disadvantages compared to original Medicare.

For limited service providers, choose one of the more popular Medicare Advantage plan types, such as an HMO plan. You may be limited in the providers you can see. You will usually face higher fees if you choose an out-of-network provider with these plans.

Other plan types do give you more provider freedom, though those plans may have higher premiums and fees like copays and deductibles.

Complex plan offerings

Using Medicare’s find planning tool, you’ll see that there are many Medicare Advantage plan options depending on your ZIP code. For some people, all these options can feel overwhelming.

Additional costs for coverage

Original Medicare charges a premium, deductible, and coinsurance for parts A and B, plus any Part D or Medigap costs.

Medicare Advantage plans often consolidate these costs, but you may notice additional fees. For example, many Medicare Advantage plans include drug deductibles and specialist visit copays.

State-specific coverage

Original Medicare offers the same coverage across the United States. However, Medicare Advantage plans may only provide specific coverage in specific service areas. If you move to a new service area, your current Medicare Advantage plan may be unavailable.

How Affordable Medicare Advantages Plans Work

First, it will help to review a few basics. Medicare comes in four parts, with Part A covering inpatient hospital care and skilled nursing. There’s no premium if you or your spouse have earned at least 40 Social Security credits.

Part B covers doctor services and outpatient hospital care. The other parts of Medicare—Part C, aka Medicare Advantage, and Part D, prescription drug coverage—are optional and offered by private insurers.
Medicare Advantage is an all-in-one managed care plan, typically an HMO or PPO. Advantage plans provide the benefits of Part A and B, including part D, or prescription drug coverage.
Some offer extra benefits not available through Original Medicare, such as fitness classes or vision and dental care.
If you opt for Affordable Medicare Advantage, you typically continue to pay your Part B premium as usual, but you will pay little or no additional bonuses for your coverage.
You generally have copays or coinsurance, but once you reach your out-of-pocket limit, the plan will pay 100 percent of your medical costs covered under Medicare for the rest of the year.
The out-of-pocket limit does not apply to prescription drugs or extra benefits.
Advantage plans generally require you to get your care from a network of doctors, hospitals, and other providers to keep premiums low. It would be best if you typically had pre-authorization for specialized care.
Original Medicare has no annual out-of-pocket limit, and for Part B services, you will have to pay 20 percent of the costs after the deductible.
That’s why many seniors with Original Medicare also purchase a Medigap plan, which covers those out-of-pocket costs if they don’t get supplemental benefits from a former employer. (You cannot have both an Advantage and a Medigap plan.)
And most in Original Medicare also purchase a stand-alone Medicare prescription drug plan.
Medigap plans also offer a flexible choice of providers. Since the coverage is accepted by any doctor or medical service that takes Medicare, the vast majority do.

Conclusion

Most people fill Medicare’s coverage gaps by buying an Affordable Medicare Advantages supplement (Medigap) plan, and a Part D prescription-drug plan, or they get both medical and drug coverage from a private insurer with an AffordableMedicare Advantage.