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Why Medicare Advantage Plans Are Bad


Summary: Medicare Advantage plans are not for everyone. But are they truly bad? When you enroll in coverage, there are several factors to consider such as costs, availability, and the plans network. Estimated Read Time: 7 min

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As healthcare costs continue to rise across the country, many seniors turn to Medicare Advantage plans as an alternative to traditional Medicare. However, despite the promises of these plans, they often come with a host of downsides that some overlook. Medicare Advantage plans may include additional benefits like prescription drug coverage, care for vision, dental, hearing aids, and maybe even a free membership to the gym. Yet, people often complain about or criticize these plans. So, what are the disadvantages of Medicare Advantage? Why are Medicare Advantage plans bad?

Misinformation and a lack of understanding can lead to Medicare Advantage nightmares. So, we are here to help clear the air. Medicare Advantage plans are not bad in every situation. However, they are certainly not a good fit for everyone. You should only enroll in Medicare Advantage coverage if it is the best fit for your unique situation. Below, we clarify why these seemingly too-good-to-be-true plans have a less-than-stellar reputation and answer the much-anticipated question of why Medicare Advantage plans are bad.

Why Do Doctors Not Like Medicare Advantage Plans?

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It is no secret that some doctors have expressed their concerns regarding Medicare Advantage plans. If you ask your doctor how they feel about Medicare Advantage plans, the answer may surprise you. There are several reasons doctors do not think fondly of Medicare Advantage Plans. These include:

  • Strict network of providers
  • The financial structure of the plans
  • Prior authorization is typically required for services

If you are on the fence about enrolling in a Medicare Advantage plan, it is important to weigh the pros and cons from your physician’s perspective. However, it is important to note that not all doctors feel this way, and some may encourage Medicare Advantage plans if they believe it is in the best interest of their patients.

Strict Network of Providers

Doctors may have a variety of reasons for not liking Medicare Advantage plans. One reason is that these plans often have smaller networks of doctors and hospitals than traditional Medicare, which can limit the choice of providers available to patients. This can be frustrating for doctors who want to provide the best possible care for their patients by providing referrals but are constrained by the limitations of the plan.

When a Medicare Advantage plan offers a limited network, receiving a referral to the best specialist may be more difficult than anticipated.

Medicare Advantage Plan Financial Structure

The average physician is not a fan of Medicare Advantage because these plans put the patients’ financial risk in the hands of the doctor. The Medicare Advantage plan carrier will pay your doctor a set amount of money upfront based on a diagnosis. So, the only way the physician will make a profit is if they stay under budget. This encourages doctors to provide cost-effective care that may create pressure to prioritize cost over care.

The complex billing and reimbursement process with Medicare Advantage plans is also a common downfall in the eyes of a physician. In addition to needing to stay under budget when providing care, Medicare Advantage plans often have different payment structures and rates than traditional Medicare, which can make it difficult for doctors to understand how they will be paid for their services.

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Prior Authorization

Another reason why doctors may not like Medicare Advantage plans is that these plans often require prior authorization for certain treatments or procedures. This means that doctors must get approval from the insurance company before they can perform certain tests, procedures, or treatments.

Obtaining prior authorization can be extremely time-consuming and can delay the delivery of care, which can be frustrating for both the doctor and the patient.

Pros and Cons of Medicare Advantage Plans

Not all aspects of Medicare Advantage plans are bad. If the benefits match your needs both medically and financially, there can be come up sides to Medicare Advantage plans.

Pros of Medicare Advantage plans include:

  • Additional benefits: Medicare Advantage Plans often offer extra benefits that Original Medicare does not cover, such as dental, vision, and hearing care. Some plans may also include fitness and wellness programs, transportation, and other services.
  • Low costs: Medicare Advantage Plans may offer lower out-of-pocket costs than Original Medicare, as well as limits on annual out-of-pocket expenses, which can help people budget for healthcare expenses.
  • Prescription drug coverage: Many Medicare Advantage Plans also include prescription drug coverage, which can be more affordable than purchasing a separate Part D plan.

Overall, if the benefits are best for you, Medicare Advantage Plans may not be entirely bad. However, it is essential to understand the overall costs related to your plan, your benefits, and the network restrictions you must abide by when receiving care.

Disadvantages of Medicare Advantage Plans

There are several reasons why beneficiaries may feel Medicare Advantage plans are bad. Some policyholders can provide a list of disadvantages, while others might be satisfied with their Medicare Advantage coverage. Based on who you ask, the answer to this question varies.

Overall, the most common complaint we hear about Medicare Advantage plans is regarding their strict provider networks and high out-of-pocket costs. Even without a low or zero-dollar monthly premium, most beneficiaries spend more out-of-pocket on a Medicare Advantage plan than they would through a Medicare Supplement plan.

Five Disadvantages of Medicare Advantage Plans

  • Coverage does not travel with you
  • The small network of doctors
  • High out-of-pocket costs
  • Plan benefits change annually
  • The constant need for referrals and approvals

You should carefully consider your priorities before signing up for a Medicare Advantage plan. By doing so, you can make an informed decision about your healthcare and ensure you receive the best possible care.

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Coverage Does Not Travel with You

Another disadvantage of Medicare Advantage plans is that coverage does not travel with you, which can be particularly problematic for seniors who enjoy traveling or who spend part of the year in a different location.

When you enroll in a Medicare Advantage plan, you are typically limited to a specific geographic area, and if you travel outside of this area, you may only be covered for emergency situations.

Small Network of Doctors

Provider networks are another significant disadvantage of Medicare Advantage plans, not only for the doctors but also for you as an enrollee. Medicare Advantage plans often have narrow networks of providers, which can limit your access to care. In some cases, you may have to travel long distances to see a provider within your network who can care for your needs. This can be especially difficult for those who have mobility issues or who rely on public transportation.

Moreover, even when you are able to find a provider within your network, the quality of care may not be of the highest level. Medicare Advantage plans are notorious for incentivizing providers to offer less expensive care, which can result in lower-quality care or limited treatment options.

High Out-of-Pocket Costs

One of the primary reasons why Medicare Advantage plans are bad for some is because of their high costs. While these plans may offer lower premiums than traditional Medicare, they often come with additional costs that can quickly add up.

For example, many Medicare Advantage plans can have high deductibles, which means you must pay a certain amount out-of-pocket before their coverage kicks in. In addition, these plans may also have higher copayments and coinsurance for certain services, such as hospital stays or outpatient procedures.

Additionally, you may be subject to paying higher costs if you receive care from a provider who is out of your plan’s network.

Annual Plan Benefit Changes

Annual changes to Medicare Advantage plan benefits can create uncertainty, limit access to needed care, and increase out-of-pocket costs for policyholders if not properly reviewed.

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When you enroll in a Medicare Advantage plan, you agree to a set of benefits and costs for a specific period of time. However, insurance companies may make changes to the plan each year, such as changes to the cost-sharing structure, drugs covered by the plan, or providers that are in-network. These changes can make it difficult for patients to adjust to new requirements, find alternative treatments, and access needed care.

If a plan increases copays or deductibles, it may be more difficult for patients to afford needed care or adhere to their treatment plans. Therefore, it is essential for patients to review the details of their plan each year and consider alternative options if the changes are not favorable to their health needs or budget.

Many Medicare Advantage Plans Require Referrals

Medicare Advantage plans often require you to obtain referrals from your primary care physician before seeing a specialist or receiving certain medical services. This can be a frustrating and time-consuming process, as you must complete this additional step before you can receive the care you need.

In some cases, you may also need to obtain prior authorization from your insurance company before receiving certain medical services or treatments. This can result in delays or denials of care, which can be especially problematic for patients with serious or urgent health needs.

Why Are Some Medicare Advantage Plans Free?

A big misconception about Medicare Advantage plans is that they are free. However, this is far from the truth. When you enroll in a Medicare Advantage plan, you are still responsible for paying the Medicare Part B premium and cost-sharing. So, unfortunately, while you may have a zero-dollar premium plan, there is no such thing as a free Medicare plan.

The main reason why Medicare Advantage carriers can offer low to zero-dollar monthly premium plans is that Medicare pays the private companies providing the plans to take on your health risk. But not all Medicare Advantage plans have a low premium cost.

Medicare Advantage carriers make their plans look attractive to entice beneficiaries to enroll. Then, Medicare pays the carrier a fixed amount per month to provide coverage to each enrolled beneficiary.

Holes in Medicare Advantage Plan Benefits

Medicare Advantage plans often offer extra benefits that you won’t find with Original Medicare or a Medicare Supplement plan. These benefits include dental, vision, and hearing care, prescription drug coverage, gym memberships, and more. However, these additional benefits can cause issues when paying for the services.

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Often, beneficiaries face disappointment when they pay more than they budgeted for when utilizing the additional benefits. Even though their Medicare Advantage plan offers coverage, they are almost always met with high out-of-pocket expenses and a low maximum benefit amount. Plus, once you exceed a certain amount of coverage for most additional benefits, you are responsible for 100% of your costs.

However, Medicare Advantage plans might work in certain situations. If you are on a limited budget and cannot afford the monthly premiums for a Medicare Supplement plan, then a Medicare Advantage plan with sufficient coverage for your health needs is a good deal.

Are Medicare Advantage Plans a Good Financial Investment?

Medicare Advantage plans are certainly worth the zero-dollar premium. However, it is your choice to decide if the coverage is right for you and your budget. The value of a Medicare Advantage plan depends on your location, healthcare needs, budget, and preferences.

So, for some, a Medicare Advantage plan might be a good financial investment. If you do not regularly attend doctors’ appointments and are in great health, you could end up getting more out of the plan than you put in. However, if a health concern eventually arises, this is when the investment could flop.

Simply, Medicare Advantage plans are good until they are no longer good for you.

Can I Enroll in a Medicare Supplement Plan Later if I Enroll in a Medicare Advantage Plan Now?

If you enroll in a Medicare Advantage plan now, you may be able to cancel your Medicare Advantage plan and enroll in a Medicare Supplement (Medigap) plan in the future. To do so, you will have to wait until the Annual Enrollment Period, a Special Enrollment Period, or the Medicare Advantage Open Enrollment Period to make changes.

It is important to know that most beneficiaries will only get a Medicare Supplement Open Enrollment Period once in their lifetime. This is your only opportunity to enroll in a Medigap plan without answering health questions.

If you miss this one-time opportunity to enroll, you will have to answer health questions should you wish to enroll in a Medicare Supplement plan in the future. This means the carrier could deny your application due to pre-existing conditions. Thus, it’s important to understand which coverage is best for you and enroll in that coverage the first time.

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Will I Pay More for a Medicare Advantage Plan or a Medicare Supplement Plan?

Although many people are initially put off by the higher monthly premiums of Medicare Supplement plans, your out-of-pocket costs each year could be higher on a premium-free Medicare Advantage plan. When you compare your total costs on each plan, you may be surprised at how much you will spend out-of-pocket on copayments, coinsurances, and deductibles.

On the other hand, Medicare Supplement plans will require you to pay higher costs initially and often lower out-of-pocket costs. However, your actual spending will depend on the amount of care you receive throughout the year. Those who only visit the doctor once annually may spend less through a Medicare Advantage plan. However, if a major health concern arises, you may spend less with a Medicare Supplement plan.

Is Medicare Advantage Right for Me?

Understanding whether a Medicare Advantage plan is right for you can depend on several factors. Most importantly, you’ll need to be sure that the plan you choose to enroll in meets your needs, both medically and financially. With all the downsides, why are they pushing Medicare Advantage plans so often? This may be because a Medicare Advantage plan could be your best option.

To ensure a Medicare Advantage plan is right for you, you will need to:

  • Evaluate your healthcare needs: Look at your current healthcare needs and consider any potential changes in the future. Make a list of your prescription drugs, doctor visits, and any other healthcare services you anticipate needing in the coming year.
  • Compare plan options: Use the Medicare Plan Finder tool to compare the costs and benefits of different Medicare Advantage plans available in your area. Look at the premiums, deductibles, copayments, and coverage limitations.
  • Consider your budget: Evaluate your budget and determine how much you can afford to spend on healthcare costs each month. Remember that Medicare Advantage plans often have different costs for different services, so it’s important to consider all the potential costs.
  • Review plan networks: Ensure that the plan you are considering includes your current doctors, hospitals, and other healthcare providers in its network.
  • Understand plan benefits: Review the additional benefits that the Medicare Advantage plan offers, such as dental, vision, or hearing services, as well as wellness programs, gym memberships, and other perks.
  • Speak with a licensed Medicare agent: Consult with a Medicare expert to help you understand your options and make an informed decision.

Ultimately, the decision to enroll in a Medicare Advantage plan depends on your unique healthcare needs and budget. By taking the time to research and compare different plans, you can find the one that is best for you.

By following these steps, you will be able to determine if a Medicare Advantage plan is right for you.

How Do Medicare Advantage Plans Make Money?

Medicare pays carriers offering Medicare Advantage plans based on a bidding process. The carriers submit their bid based on costs per enrollee for medical services Original Medicare covers. Suppose the bid is higher than the benchmark amount. In that case, the enrollee will pay the difference in the form of monthly premiums, which is why some Advantage plans have a zero-dollar premium and others have a monthly premium.

Are Medicare Advantage Plans Good or Bad?

Depending on your situation, a Medicare Advantage plan may not be the best option for you. However, different circumstances warrant different plan types. Ultimately, it is crucial to know what to expect from these plans – regarding price and coverage – and become educated on which options are affordable to you and provide the coverage you need.

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When determining if a Medicare Advantage plan is bad or good for you, you should thoroughly compare all plans available to you. Then, you can determine which plan best fits your needs and which ultimately fits your budget. This is the best way to determine which plan type is best for you. Remember, everyone’s situation is different, so what works best for you may not work best for your spouse or neighbor.

What is the Biggest Downside to Medicare Advantage Plans?

One of the biggest complaints we hear about Medicare Advantage plans is the lack of freedom and high out-of-pocket costs for services. Although these plans often boast a low monthly premium, they are commonly met with high deductibles and out-of-pocket costs. So, in some cases you may be better off paying a higher premium up from to have lower overall costs in the end.

However, cost is not the only downside to Medicare Advantage plans. The lack of network availability in some areas is another significant downside to Medicare Advantage plans. For some, the importance of seeing whichever doctor you prefer is a deal breaker. However, if you enroll in a Medicare Advantage plan, you may not be able to have this option.

What is the Worst Medicare Advantage Plan?

The worst Medicare Advantage plan for you is one that is not suitable for your needs and budget. If you enroll in a plan that is not right for you, you could be stuck with subpar coverage, high costs, and doctors that you do not prefer.

If you decide that a Medicare Advantage plan is best for you, it is essential to still research which Medicare Advantage plan is best for you. Not all Medicare Advantage plans offer the same benefits. Thus, understanding your plan is key to a successful future with your healthcare plan.

How To Get Help with Decisions About Medicare Advantage

If you are considering enrolling in a Medicare Advantage plan but are hesitant, we are here to help you make an informed decision. The key to obtaining the best coverage for you is researching plans in your area and becoming educated on your options.

Whether you feel a Medicare Advantage plan is right for you or wish to explore Medicare Supplement plans, our unbiased licensed agents are here to help. We ensure our clients are happy and receive a Medicare plan that fits their budget and healthcare needs.

Our licensed agents thoroughly work with you to compare the top-rated plans in your area. To speak to an agent about your options, call the number above. If you can’t call, complete our online rate form to begin your plan comparison today!

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Sources:

MedicareFAQ is dedicated to providing you with authentic and trustworthy Medicare information. We have strict sourcing guidelines and work diligently to serve our readers with accurate and up-to-date content.

  1. Medicare Advantage Plans, Medicare. Accessed March 2023.
    https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/medicare-advantage-plans
  2. Medicare Advantage 2022, KFF. Accessed March 2023.
    https://www.kff.org/medicare/issue-brief/medicare-advantage-2022-spotlight-first-look/
  3. How Do Medicare Advantage Plans Work, Medicare. Accessed March 2023.
    https://www.medicare.gov/sign-upchange-plans/types-of-medicare-health-plans/medicare-advantage-plans/how-do-medicare-advantage-plans-work
  4. What is Medicare Part C, HHS . Accessed March 2023.
    https://www.hhs.gov/answers/medicare-and-medicaid/what-is-medicare-part-c/index.html

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55 thoughts on “Why Medicare Advantage Plans Are Bad

  1. I will be 65 in January and cannot decide what is better medigap or advantage. My question is if I go with advantage hmo and go to a doctor not in my network and have to pay 100% for services does my payment go towards my out of pocket expense?

    1. Tamara, the decision between Medicare Advantage and Medigap is a tough one when you are new to Medicare. If you go to a physician not in your network, those costs do not go towards your out-of-pocket expenses. If you would like to speak with an agent who can help you weigh the pros and cons of both plan types, we have Medicare experts available for you!

  2. I’m 69. I have always kept the original Medicare until this year. It’s 1/23/23 and I’m already sorry I changed. Is it possible to get the original back since it’s so early in the plan year. I have a surgery on the 30th but it will cost ME $546. I don’t have the money to pay, if I don’t get the surgery the abnormal cells can become cancer.

    1. Hi Pamela, We are currently in the Medicare Advantage Open Enrollment period meaning you can drop you Medicare Advantage plan and return to Original Medicare. However, you may also be eligible for a Trial Right if this is the first time you have enrolled in a Medicare Advantage plan. This way, you’ll be able to return to the plan you had prior to making a change. If you would like, one of our licensed agents would happily help you sort out your coverage. Complete our online rate form for more information.

  3. I have worked in Revenue Cycle for the past 46 years and from what I have seen and experienced I am not a fan of any of the Medicare Advantage plans. I am currently still employed but when I turned 65 I did sign up for Medicare Part A. For everything else I still use my employers insurance plans. I am also in good health right now. My question is: If/when I have to retire, what is the procedure for getting Medicare Part B and the necessary gap and dental/vision insurance? Will I be penalized for staying employed?

    1. Hi Ellen, when you retire you will want to then enroll in Medicare Part B for healthcare coverage. Once you have enrolled in Part B, you will receive a Special Enrollment Period to enroll in a Medicare Supplement plan without underwriting health questions. At this time, you can also enroll in dental and vision coverage. As long as your employer plan is creditable to Medicare, you will not be penalized for continuing employer coverage while you are actively working.

  4. I am 76 and lived in Las Vegas. I retired in July 2020. I had full medical coverage (Uhc, epo) by my employer until the time of my retirement. To continue with their medical coverage, I had would have been very costly. I choose an Aetna Medicare Prime Plan with all of my providers listed in the plan. Seven/eight into the plan all providers stopped accepting the plan, including Aetna stopping coverage to a doctor I had been seeing for more than eighteen years. To keep it I would have had to accept another doctor I had never seen. I choose not to do this and held my breathe hoping nothing would happen until I could get another carrier. This insurance would still be in effect until the end of the year but having to choose all new doctors. During this period, I knew I would be moving to NC and would have to change and choose an acceptable insurance for that state.
    I informed Medicare of my move and was informed I had a two-month grace period from the date I notified them to choose another carrier. which ends February 7. My research now has me leaning towards medigap, but I would want a plan that offers me hearing, dental, vision, drug coverage and one that travels with me. I am confused about the different parts and how best to apply them to my needs. Am I still eligible for a medigap as I have had an HMO?
    Hopefully you can give me some insight and/or steer me in the right direction.

    1. Patricia, you are eligible for a Medicare Supplement due to the move even though you were previously on a Medicare Advantage plan. I recommend speaking with a licensed agent to help you decide which plan best fits your needs. You can always enroll in a Medicare Supplement and add prescription, dental, vision, and hearing coverage. If you would like help from one of our agents, complete this form [insert link] and we would be more than happy to work with you.

  5. My wife and I have always had a Medicare Advantage Plan. Recently a doctor told her he did not accept the Advantage provider we have, so, can the provider take our Medicare coverage instead?

    1. Mark, Medicare Advantage Plans are an alternative to original Medicare coverage, making it your primary source of insurance. When you are on a replacement plan, you do not have the freedom to choose any doctor or hospital – you must follow the network of your elected plan. If you are looking for coverage that will cover you at any Medicare accepting doctor nationwide, you would need to go back to Original Medicare and pick up a Medicare Supplement.

  6. I am 67 and have original Medicare, medigap policy and drug policy. No health issues. I am considering advantage plan. What are your thoughts? Thanks.

    1. Hi Trudy – if you’re interested in trading in Medigap for Medicare Advantage, you’ll want to make sure the policy of your choice covers your preferred physicians, as well as your prescription medications and their dosages. You’ll get a trial right for a year on a Medicare Advantage plan and you can switch back to Medigap if you are not satisfied with it.

  7. My husband’s Oil company recently dropped their version of Medigap for retirees with no notice at all. My husband has been on a Kaiser Medicare Advantage HMO plan for the past 2 years. Previously the company said that he would be able to switch between Medicare Advantage choices and their UHC medigap plan at any open enrollment period. This year they said NO..only those already on it would be grandfathered in. Those on Medicare Advantage would have to stick to a Medicare Advantage plan. Given that my husband is past the 1 YEAR look back period to get an outside Medigap plan with no issues……is this situation one where Medicare would reconsider and allow him to enroll in a Medigap (without dealing with pre-existing conditions/issues etc) at the rate he would have gotten at 65….or is he just stuck?

  8. Thank you for this information. I went with a Medigap plan when a friend asked at our leading cancer hospital if her medicare plan would be accepted there. The answer was “no.” That did it for me. We have cancer and heart disease on both sides of the family. Pay me now, or pay me later. Better now while I can still work and negotiate payments then later when I’m less able.

  9. Hello! My husband & myself currently have Medicare part A & B plus FEHB with dental & vision coverage.
    Our question is, will it be better if we switch our coverage to Medicare Advantage but still keep our FEHB with dental & vision coverage.
    Thank you

    1. Hi Carolina, Medicare Advantage includes dental and vision coverage as well and you will still need to pay your Part B premium when you have an Advantage plan. You may not want to take on that coverage if you already use your FEHB for such services.

  10. I read all your answers to the above questions. They are very good. I have Medicare Plan B supplement through BCBS Anthem, Plan-F, Paying$281.17/month. Is there another insurance company with the same plan with lower monthly premiums? I pay $112.70/month for Part D. I appreciate the answer. Thank you.

  11. You can wait on applying for Part B and he will not be penalized because he has “creditable coverage”. DO NOT go with an advantage plan. It will be a major DISADVANTAGE to him. If you did happen to get into an advantage plan the only way to return to original medicare is by applying for Part D. Medigap/supplements are GREAT. But if he has his VA benefits just stuck with Part A and that! Best of luck!

    1. Hi Britt! Great advice on Medicare Advantage. However, I would recommend they delay Part B. Veterans benefits are not considered creditable coverage. If they were ever to enroll in Part B later, they would be penalized.

  12. I am a Physician MD in primary care and when I look at re-imbursement on medicare advantage plans I am only getting 50% payment. We cannot afford to see these patients. I also had a patient that had to pay $6800 because the hospital was not signed up to them. We are about out of business and this may be the final nail in the coffin

    Thx Rick D Schoeling MD

    1. Those who insist on “Medicare For All” might succeed, but end up with “Medicare Advantage For All”. That is, those who do not qualify for standard Medicare will be given only Medicare Advantage, and, of course, also pay the monthly Part B premium. This way, Medicare can be paid up front be the Medicare Advantage insurance companies and pass on to THEM the cost of providing the medical care, which, as we know, often results in unexpected huge costs for patients and both pathetic payments and never-ending administration filings for physicians
      PLUS, not being on traditional Medicare, they will NOT be able to purchase a Medicare the supplement plan.

      Talk about a mess!

  13. Hi Jan! This is a VERY common question we get. Those with VA benefits enroll in Part A since it’s premium-free anyway. The main reason it’s recommended you get Part B is so that you have the option to get outpatient care outside of a VA facility if ever needed. Mostly, I see this issue come around when a retired veteran moves somewhere that does not have a VA facility close to them. They decide to enroll in Part B at that time and find they have a hefty penalty to pay. Since VA benefits are not considered creditable coverage, Medicare will penalize you for delaying enrollment if you choose to enroll at a later time. There are risks that come along with Medicare Advantage plans, which is why it’s important to weigh out the pros and cons of them. Keep in mind, you still have to enroll in Part B to get a Medicare Advantage plan. So regardless if you go with Medicare Advantage or Medigap, you still have to have Part B and pay the Part B monthly premium. Medicare Advantage is good for those who are healthy, the issues arise if and when you get sick. For those who don’t want to pay a high premium for Medigap, but find an Advantage plan too risky, the high-deductible Plan G is always a good alternative. The premium is usually somewhere between $50-$80 per month. So if you went that route, you would pay the Part B premium of $148.50 and the Medigap premium of around $50, putting you in the ballpark range of $200 a month. You mentioned, “don’t think we want to pay for “Medigap” either that he may never use” that I wanted to touch on. If you ever have to go to a non-VA facility and use your Part B benefits, you will use your Medigap benefits at that time since it will cover the 20% coinsurance Part B leaves up to you to pay. There are a lot of factors that come into play here. It really depends on your specific situation including health, budget, and long-term goals. If you need help deciding, just give us a call!

  14. Lindsay, I believe it’s not just about comparing premiums of F versus G when signing up. Is a Medicare Supplement plan is to be a purchase decision for the long-term then one should consider which plans have more stable rate increases. Plan F, due to it being a closed plan, only available for people age 65 before 1/1/20, covering more out-of-pocket costs, and a required plan (actually either C or F) along with A for someone who qualifies for guaranteed-issue rights, is expected to have the highest, more unstable rate increases. This is followed by Plan G with Plan N supposedly being the most stable. Although it’s important to evaluate the immediate costs, it’s also critical to consider long-term costs. Of course, we can’t predict the future and anything is possible but we can study trends and data and make informed, educated decisions.

    1. Hi Noah! Thank you so much for your feedback. You’re 100% correct on all points you mentioned. Unfortunately, it’s impossible to predict the long-term costs of a Medicare Advantage plan since they change annually. At least with the right data, you can mostly predict your long-term costs with a Medigap plan since you only have to take your monthly premium into account and not copays or coinsurance.

  15. Someone was complaining about proposed medicare rule changes to Medicare Advantage plans, but they could not tell me what these changes are, nor could I find them online. Are there proposed changes and what are they ? Thank you

  16. My husband is retired and disabled. He has been on Medicare and also a medigap plan (Aetna) through his former employer. He has an auto immune disease and has had several joint replacements. He has been hospitalized 4 times this year. His company is pushing to change to a Medicare Advantage plan but I am concerned about the co-pays for hospitalization ($200 per Day). the problem we are having is that the hospital that he has been using to get his IVIG infusions through is ending their relationship with Aetna. They say they will continue with Medicare Advantage plans through Aetna, but not regular Aetna insurance. I am leaning on staying with his current insurance and just finding a different location to get his monthly (and VERY costly) treatments. Which would be better?

    1. Hi Elaine. If the hospital takes Medicare they are required to take a supplement. It’s extremely rare that a hospital would accept Medicare but only Medicare Advantage plan. Given your husband’s health issues, I would not recommend he switches to Medicare Advantage. I agree that your best option is to find a different location for him to receive his monthly treatments. I hope this helps!

  17. If you live in an ISSUE AGE state and buy a Medigap plan, your current age wii never be a factor in your monthly premium. So as at age 65 I purchased plan J (which has since been replaced by plan F), though I am now 79, the premium has not increased very much……But regardless, it is clear to me that if you can possibly afford it, get a Medigap plan as early as possible and stay with it, even if means no more tattoos, no more hot wheels, no more knee jerk travel, no more designer jeans, no more gold jewelry, nor other gottahaves.

  18. Lindsay, how refreshing to read your responses with compassion and knowledge. Quick question: I am 64 and my wife will be 65 this coming Feb. I am currently employed and have group health coverage as long as i am employed which could be many years in the future. i have contacted SS and they are telling me that we do not have to come in and apply for Medicare as long as we are under a group. Here is the kicker: I have found out that if you bypass the Medigap initial offering and develop some serious medical conditions, then the next open enrollment you could be denied and then up a creek. Would we be waiving that initial offering by staying with our existing group coverage? Many thanks…….

    1. Hi Gordon! Thank you for the positive feedback! As long as your employer has more than 20 employees, the coverage is considered creditable under Medicare and you can delay enrolling in Part B. Your Medigap Open Enrollment Period does not begin until your Part B is in effect. If you develop serious health conditions and leave your employer group insurance, you will have an 8-month Special Enrollment Period to enroll in Part B. Once you know when your Part B starts, you can apply for Medigap without your health conditions impacting your enrollment.

  19. I will be turning 65 in April, 2021, and live in the state of Tennessee. I am currently paying for insurance through my employer, but will not be able to keep this policy after 2021 (due to loss of required hours). The cost of the premium is $530 per month for my husband and myself. My plan is to enroll in Medicare Part A and B, and probably a Medigap policy. My question is this. . . should I (or more importantly, CAN I) enroll with my employer during our current Open Enrollment, so that I have coverage for January, February and March; and then cancel the employer insurance once the Medicare goes into affect in April? Is this the proper way to handle this situation? And can I apply for Medigap coverage if I am already insured? If I re-enroll during Open Enrollment, will I be required to pay the $530 per month for the whole of 2021? Any help/advice/suggestions you might have are welcome!!

    1. Hi Becky! Yes, under normal circumstances you can cancel employer group coverage at any time. Your Initial Enrollment Period will begin in January. This is when you can start the enrollment process into Medicare Part A and Part B. Your benefits will become active on the 1st of your birthday month if you enroll before your birthday month. Then, once your Part B is in effect, you have a 6-month Open Enrollment Period to enroll in a Medigap plan. So yes, you can enroll in employer coverage now and cancel once your Part A and Part B become effective in April.

  20. Hello — I will retire on jan 1 of 2021 and will re-enroll in Medicare Part B. I have been covered by my employer health insurance plan but cannot take this same plan with me into retirement. My employer offers a medicare coordinating plan called Advantage 65 with medical and dental and vision for a monthly premium of 408.00 for my wife and I. This does not include prescription drug coverage. The 408.00 premium does not include the Part B medicare premium of 288.00 so the total monthly cost will be 696.00 month. This seems like a large sum to 2 people. This Advantage 65 plan is not a medicare advantage–it is a medigap policy. Any advice is appreciated.

    1. Hi Robert. Medigap plans do not include coverage for dental and vision, Medicare Advantage plans do. Advantage 65 sounds like it is in fact a Medicare Advantage plan through your employer. Without seeing the plans summary of benefits, it’s hard to say if the premium sounds high or not. It may include lower copays, a larger network of doctors, or travel coverage which is why the premium could be higher. I would compare the cost of what your employer is offering to a Medigap plan with a dental, vision, hearing plan and stand-alone Part D prescription drug plan. That could very easily cost you less in monthly premiums than the Advantage 65 plan and provide you better benefits. Give us a call and we can help.

  21. Hello My father is 84 years old and in the hospital. He will likely need 24/7 care. I learned that he has Medi-Care Advantage HMO and I know he also has Medi-Cal ( California) . At one point I was told he had Medi- Medi. I am told that the Medicare HMO is making it difficult. He needs to go to a skilled Nursing for rehab and I am not able to provide 24/7 care for him after rehab. Should I be looking to get him out of the HMO???Can you please help me with some information or refer me to someone that might be able to help me? Thank you

    1. Hi Christine. I’m sorry to hear about your father. If he has Medi-Cal, which is Medicaid, they should cover the expenses at the Skilled Nursing Facility. With your Medicare Advantage HMO, you’ll need to stay in that plan’s network, which could make care coordination more challenging. If he is eligible for an Institutional Special Needs Plan, you may want to look into that and get him out of his current HMO. CMS has information on I-SNPs as well. I hope this helps!

  22. Hi Terry! You will always have better coverage with a Medigap plan than a Medicare Advantage plan. You have to decide if you rather pay more in monthly premiums to pay very little to nothing out of pocket as you use the benefits, or if you rather pay a low premium to pay more out of pocket as you use the benefits. If these conditions require doctors’ visits, with multiple doctors, as well as testing and treatments, it would be best to enroll in a Medigap plan. If you give us a call we can help you compare Medigap vs Advantage side by side to see which option will be the better choice for you. I hope this helps!

  23. Our employer-sponsored retiree health insurance is planning on a possible change to a UHC Medicare Advantage PPO from a regular UHC PPO. We are in discussions. What would be some of the questions and issues we should address before voting?

    1. Hi Holly! This question is difficult to answer without knowing more information about what type of employer coverage you have with the UHC PPO plan currently. UHC PPO may or may not work similarly to a UHC Medicare Advantage PPO. I recently updated our FAQ article on Medicare Advantage vs. Medicare Supplements that should help guide you on what questions to address before voting. For example, I would be asking questions like “what copays can you expect to pay out of pocket when you visit your providers now vs. Medicare Advantage PPO”, “what providers are in your current network vs. the Medicare Advantage PPO”, “what is the out-of-pocket maximum spend limit currently compared to the Medicare Advantage PPO”, etc. I would think the questions would be similar to the same questions you would ask when comparing Medigap with Medicare Advantage. I hope this helps!

  24. I have a niece that I have became her guardian through the courts . She has disability due from mental retardation from birth. Her father worked and kept her on his Insurance with his job. Now her Father got cancer in 2012 loss his job his home and filed for Medicare for his daughter then, how ever part D was not a law to have then as he continue to fight for his life while he took care of his daughter and 4 young grandsons they never made them selves guardians of their daughter as they did not know they needed to nor did he understand he ever needed to get a part D coverage for her she is 40 yrs now and he has passed a way . I am now playing catch up trying to get her a supplement plan or advantage plan to go with her Medicare . Now they are telling me she will have a Life time late enrollment penalty . Really she is like a 3 or 4 yr old who needs lots of daily help and her dad fought for his life every day he could. She isn’t 65 yrs she is healthy and takes no medicine at now . I am trying to do my best but this means she will pay a pentacle from 2015 to 2019 1% a month .this seems unfair since she could not help her self and her father was fighting every day for his life. Is this really true or is there any thing I can do to avoid this penalty for her .

    1. Hi June. I’m so sorry about your current situation regarding your niece. Unfortunately yes, she will have a penalty for the rest of her life. If her income is low and she qualifies for Medicaid or Extra Help, her penalty would be waived. You could sign her up for a Medicare Advantage Plan that covers prescription medications and only have to pay the penalty she has incurred over the last four years. The 2020 Part D premium is $32.7, so if she went that route she would only have to pay somewhere around $16 per month. ($32.74 x .48 {4 years} = $15.71) The sooner you sign her up, the better. That way she will stop increasing her penalty and it will stay where it’s currently at. If she were to get a supplement plan & pick up Part D now, the monthly premium would be around $48.50. ($32.74 + $15.71 = $48.45) I would recommend looking into getting her Extra Help to see if she can get her penalty waived. I hope this helps!

  25. My husband is 79 and underwent chemo/radiation in 2018; cancer is now gone. however he is undergoing speech and swallowing therapy. We have a medicare advantage thru humana. Everytime there is a procedure or scans, xray we pay a co-pay of $325 or 220 or 180. Amaximum out of pocket of $10,000 for medical and meds together. Is there a better plan? he also has afib and kidney disease and copd. I have the same plan as him, my ailments are not as devastating but I do have a few. Suggestions?

    1. Hi Ruthie! Unfortunately, your husband would not be approved for a Medigap plan. I would recommend two things in your situation. First, work with an agent during each AEP, which is right now, to find a lower cost advantage HMO if possible or PPO with all doctors in-network so his maximum out of pocket costs are lower. Second, since you’re a little healthier, you may be eligible for a Medigap plan. That would lower the total out of pocket costs between both of you.

  26. What would you suggest for a 59 year old female with malignant ascites, I have ssdi and they are putting me on medicare but no information on what my options are. I live in Washington state.

    1. Hi Peggy! Unfortunately, not all states require carriers to offer Medigap plans to those on disability. Washington is one of those states that don’t require it, but some carriers may still offer it. However, the monthly premiums are usually higher for those on disability when compared to those that aged into Medicare.

      What most beneficiaries do in your situation is they enroll in a Medicare Advantage plan until they turn 65. Once they turn 65, those on disability will get another Open Enrollment Period that allows them to sign up for a Medigap plan. During this six-month window, you cannot be turned down due to your disability or charged higher premiums.

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