2 Truths and 3 Lies About Medicare Advantage Plans

truth vs lies about medicare advantage plans

Do you get confused when you hear terms like Medigap, Part D or Open Enrollment? If so, you’re not alone! Maybe you’ve just turned 65 or you’ve recently left an employer-sponsored plan. Or, perhaps you’ve been on Original Medicare for years but haven’t recently put any intentional thought into new options. 

Whatever the case may be, as you start to research your healthcare options you might notice a disturbing trend. The information about Medicare coverage, specifically Medicare Advantage, can be inconsistent and unreliable.

This is a frustrating reality most seniors face when looking for a Medicare Advantage Plan. Unfortunately, some organizations—whether they’re businesses or special interest groups—do try to defraud seniors by making false claims about what Medicare Advantage is and isn’t.

Today, we’re drawing a line in the sand. We’re here to give you the facts about Medicare Advantage and address some of the fiction you may have heard.

FACT: Medicare Advantage is private insurance

Private insurance companies first offered Advantage Plans in 1997 as an alternative to Original Medicare. These policies combine inpatient and outpatient services in addition to benefits like prescription drugs, vision and dental. Under Original Medicare, you only get inpatient and outpatient care. In addition, you have to purchase prescription drug plans separately.

FACT: Medicare Advantage is affordable

These plans are usually on the cheaper end of the Medicare spectrum. And most of them even include coverage for prescription drugs, vision and hearing. Premiums are very low and usually have out-of-pocket spending caps, but they only apply to services covered by Original Medicare.

But don’t let the low prices deceive you. Medicare Advantage can become very expensive if you don’t use an in-network provider or have a chronic medical condition. So when considering an Advantage Plan, try to anticipate all your out-of-pocket expenses and how they’ll add up with Advantage compared with Original Medicare. 

FICTION: Medicare Advantage works for everyone

Many people like the options Advantage Plans provide and the all-in-one benefit package. However, they’re best for seniors who are in relatively good health and living in an area with options for in-network providers. If this is your situation, an Advantage Plan can save you money and provide quality health care.

Seniors who have complex or chronic health conditions should avoid Medicare Advantage, as their treatments, prescriptions and other care needs might not be covered by a standard Advantage Plan.

To ensure your medical needs are covered, review your Annual Notice of Change (ANOC) when it is sent out each fall. A recent study uncovered that 57% of beneficiaries don’t check the ANOC regularly! Both Advantage Plans and Original Medicare change from year to year, so connect with your agent to discuss how any changes to your plan will affect you.

FICTION: Medicare Advantage only works in big cities

While Original Medicare provides the same coverage to all beneficiaries, Advantage Plans differ based on the providers in your area. In general, those in rural areas will have fewer Advantage Plan options than those in urban areas.

But that doesn’t mean that Medicare Advantage is only for city dwellers. Before selecting a Medicare Advantage plan, make sure your preferred doctors and specialists participate. If they don’t, or there are too few options in your area, you may want to reconsider choosing an Advantage Plan.

FICTION: Beneficiaries regret choosing Medicare Advantage

This is a common misconception, which is simply not true. A study in 2021 found no significant difference regarding satisfaction of care or access to care when comparing Advantage Plan holders to those with Original Medicare.

When you have questions about Medicare Advantage or any other type of Medicare coverage, we’re here to help. Call us at 877.255.6273.


image credit: shutterstock/Gustavo Frazao