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8 Truths Every Senior Should Know Before Purchasing a Medicare Advantage Plan
1) Do not compare the premium of a Medicare Advantage Plan to a Medicare Supplement Plan.
- A common trick many Medicare Advantage Salespeople use is to try to compare the premiums of a Restrictive[RK1] Medicare Advantage Plan to that of your Comprehensive Medicare Supplement Policy.
- However, lower price is no more a reason to buy a Medicare Advantage Plan and give up Medicare Parts A & B than it is to buy a Scooter rather than a Cadillac just because it costs less.
- To compare prices and come up with a good decision, you must make sure that you are making apples to apples comparisons. This is practically impossible with Medicare Advantage Plans and Medicare Supplement Plans as they vary in benefits and structure.
- Medicare Advantage Plans are only required to be similar to Medicare Parts A & B alone, not Medicare Parts A & B when paired with a Medicare Supplement.
- Medicare Supplement Plans along with Medicare Parts A&B normally offer many more benefits and freedoms than Medicare Advantage Plans[RK2] .
- In the end, you get what you pay for.
2) To enroll in a Medicare Advantage Plan, you must give up coverage from Medicare Parts A &B.
- If you choose a Medicare Advantage HMO, PPO or Private Fee For Service Plan, you will be disenrolled from Medicare Parts A&B.
- The Federal Government via Medicare will then pay the Medicare Advantage plan to provide your health care.
- The plan may require you to pay an additional premium and may charge you a copayment each time you go to the doctor.
- To join a Medicare Advantage plan, you must have both Medicare Part A and Part B, not have end-stage renal disease, and live in an area that has a plan. Not all plans are available in all areas of your state.
3) You can have increased control over your choice of healthcare providers with Medicare Parts A&B alone rather than a Medicare Advantage Plan, even without a Medicare Supplement (Medigap) Plan.
- Medicare Parts A&B allow you to choose and physician or hospital in the United States.
- In critical times, this freedom to choose and access the best providers could make a huge difference in treatment, and even save your life.
- Medicare Advantage Plans are not so flexible, possibly with severe consequences[RK3] .
- Medicare HMOs and PPOs require you, in most instances, to use only physicians and hospitals in the PPO or HMO´s network.
- You can generally go to any doctor or provider you want with a private fee-for-service plan but you must find a provider that will treat you and accept the plan’s terms and conditions.
- Doctors may stop accepting Private Fee for Service Plans without notifying you, leaving you stuck in a plan without your physician and without Medicare Part A & B.
4) Medicare parts A&B alone (without a Medicare Supplement) can provide you comparable benefits to Medicare Advantage Plans
- Without restricting your ability to choose your healthcare providers
- Without putting administrative restrictions on your physician for claim payments and referrals.
5) Why Medicare A & B alone is better than Medicare Advantage Plans
- Medicare Advantage Plans must provide, by law, at least the same benefits (or actuarial equivalent) of Medicare. However, this can be deceptive.
- What this means is that they will offer you benefits based on dollar amounts only that will average what Medicare offers, though they may package the benefits differently.
- Packaging differences can best be explained by taking a dollar away from you in one place and giving it back in another, which maintains the “actuarial equivalent” requirement.
- However, though the average payments will be similar after care has been received, Medicare Advantage Plans may restrict or delay you from receiving treatment at that you would choose if your insurance coverage allowed you whatever you wanted[RK4] .
- Preventing you from getting care or choosing to get care means big profits to Medicare Advantage Plans[RK5] .
6) Do not purchase a Medicare Advantage Plan solely to get Prescription Drug Coverage
- If you are eligible for Medicare Advantage Plans, you are eligible for Medicare Part D plans.
- You can keep Part D Prescription Coverage without giving up Medicare Parts A&B or your Medicare Supplement Policy.
7) A Medicare Advantage Plan will restrict your right to choose your physicians and hospitals, even with Private Fee for Service Plans, possibly resulting in serious health consequences.
- Medicare Advantage Plans only require that they offer you a certain type of healthcare[RK6] .
- For instance, if you needed treatment for colon cancer, for instance, they would have to allow you to see physicians and hospitals that treat cancer. However, if you chose to take advantage of the increase in survival rates demonstrated by a particular hospital that specializes in cancer treatments and a particular physician who specializes or has great experience in colon cancer, you may not be allowed to use them. Or you might experience severe delays with your Medicare Advantage Plan.
- What’s worse, if you decide to use a provider that is not part of the Medicare Advantage plan’s network and pay on your own, you will be responsible for 100% of all costs.
A Medicare Advantage Plan may choose not to renew their contract with Medicare each year in any area.
- If this happens, you will no longer be allowed to participate in the plan.
- Medicare Supplement Plans and Medicare, however, are guaranteed renewable for life.
- You can never lose Medicare Supplement Coverage as long as you pay your premiums.
- What’s Important About Making Health Care Decisions with Health Insurance?
- Remember, the reason that you have health insurance is not solely for the sake of having health insurance.
- Health insurance for the sake of merely having insurance is boring and expensive.
- You purchase insurance to ensure that, if and when health problems occur, that you will be able to receive the best quality health care without regard to the costs involved.
- Many Seniors make the mistake of simply purchasing insurance based on the monthly cost, possibly exposing themselves to serious health risks caused by reduced access to healthcare.
- Remember, the decision you make now will determine what access you have to quality of healthcare in the future.
- The right decision can add years to your life and quality of life to your years.