Why Are Medicare Advantage Plans Bad –Or Are They?

Let’s start off with this: most Medicare Advantage Plans are not bad. There are people who truly benefit from them. In fact, there are over 26 million people enrolled in Medicare Advantage making up nearly half of all Medicare beneficiaries.ⁱ However, there are pros and cons, and these plans may not fit everyone’s lifestyle.

Let’s look at what you need to know when considering if Medicare Advantage is good or bad for you.

What you’ll learn:

What Are the Advantages of Medicare Advantage?	Jump to
What Are the Disadvantages?	Jump to
What About the Extra Benefits?	Jump to
How do I know if MA is good or bad for me?	Jump to

What Are the Advantages of Medicare Advantage?

Let’s start with the advantages of Medicare Advantage (MA) Plans. We’ll focus on our top four:

1. All-in-one coverage with extra benefits
2. Low premiums
3. Limits on out-of-pocket costs
4. Opportunity to change plans annually

Medicare Advantage includes hospital and medical coverage in one plan. One of the major pluses – depending on your personal situation – is the fact that MA plans also provide extended benefits beyond what you’ll find in Original Medicare (Part A and Part B). This typically includes:

• Vision care, including glasses and contact lenses
• Dental care, including dentures, exams, and X-rays
• Hearing care, including hearing aids and testing
• Prescription drug coverage
• Gym memberships and wellness programs

In addition, many MA plans also offer $0 premiums; others’ premiums, while not free, are low. Some plans may even offer a Part B premium reduction with their plan of up to $170 off. 

You may also save money given the fact that MA plans offer a maximum out-of-pocket (MooP) amount as opposed to Original Medicare, which has no such cap. In 2022, the Medicare Advantage MooP is $7,550, though some plans may set lower limits.ⁱⁱ

Eligible out-of-pocket costs include:

• Coinsurance
• Copayments
• Deductibles

Finally, MA plans can change annually. This opens you up to the opportunity of finding better coverage each year. You can take advantage of plan changes during the fall Medicare Annual Enrollment Period between Oct. 15 – Dec. 7.  

What Are the Disadvantages?

Many people mistake a $0 premium for a free Medicare Advantage Plan. This is not the case. Enrollees can sometimes find themselves disgruntled when they learn that they are responsible for copays, coinsurance, deductibles and other out-of-pocket costs.

Unlike Original Medicare which allows you to see any provider that accepts Medicare, MA plans feature provider networks. These network limitations may translate to greater costs if you choose to see someone out of network for your health care. This applies to all the plan’s services, including those that are typically provided by Medicare Parts A and B.

A few questions to ask about provider networks when comparing plans:

• How much do I pay for in-network services?
• How much do I pay for out-of-network services?
• How can I find out if my providers are in-network?
• What happens if my provider stops participating in the network?
• What happens if I need covered treatments that aren’t available from network providers?
• Who can I contact with questions or concerns?

Provider networks also mean an ongoing need for insurance approval of coverage and doctor referrals to specialists – something that can prove time-consuming and challenging to manage.

If you like to travel, keep in mind that MA plan coverage does not always give coverage in the places you may wish to go. MA plans can prove limited by their service area—should you leave it, you may not receive coverage.

That said, some MA plans do offer domestic and/or foreign coverage, but you need to make sure that this is the case with your individual plan. Also, keep in mind that costs for this can be unpredictable when it comes to out-of-network providers.

How Do I Know if Medicare Advantage is Good or Bad for Me?

There is no one-size-fits-all in health care. While MA plans may suit some lifestyles, they may not be right for others. You may benefit from these plans if you:

• Seek more affordable premiums
• Wish to limit your out-of-pocket spending
• Like the idea of coordinated care from provider networks

However, MA plans may not work for you if you:

• Want more freedom of provider choice
• Don’t want to get referrals to see specialists
• Don’t reside in an approved service area 

Make sure you review your individual needs before deciding whether an MA plan is right for you. Learn more about finding the best Medicare Advantage Plan for you here.

What About the Extra Benefits?

One of the major factors that MA plan fans tout is the extended benefits mentioned above, including dental, hearing, and vision as well as prescription drug coverage. Thing is, paying for these may cause some issues as you will likely experience high out-of-pocket copays.

That said, if you are looking for extended benefits on a bit of a budget, an MA plan may work better for your needs than, say, a Medicare Supplement Insurance plan. It may also work better if you:

• Want your coverage bundled in a single plan
• Need a plan that specifically addresses chronic health issues

Remember that you cannot have both Medicare Advantage and Medicare Supplement Insurance simultaneously. You must choose one or the other, though you are not required to purchase either.

The Bottom Line

While not all Medicare Advantage Plans are bad, there are can be some disadvantages. That’s the reason that it’s crucial to understand how these plans work so that you can select the right one for your individual needs.  

If you have questions, we have answers! Call an Ensurem agent at the number on this page to compare plans and get the inside scoop. We’re here to help!