Many Medicare recipients are unwittingly getting trapped in restrictive Medicare Advantage plans without knowing all the facts.  Here are a few solid pointers that will help you and your loved ones know what you're really getting into before you take the plunge.   Be sure to read all the way through to my recommendations on the bottom of this article. 


Medicare Advantage Plans vs Medicare Supplement and Medigap Insurance

1) You should not make a decision to buy a Medicare Advantage Plan by comparing the premium of the plan to your Medicare Supplemental Plan

Many Agents will try to compare your Medicare Advantage plan premiums to that of your Medicare Supplemental policy, and they are normally lower.

However, a lower price is no more a reason to buy a Medicare Advantage plan and give up Medicare Parts A and B. than it is to buy a scooter rather than a Mercedes just because it costs less.

To compare prices and come up with a good decision, you must make sure that you are making an apples to apples comparison. This is impossible with Medicare Advantage Plans and Medicare Supplemental Plans as they vary in benefits and structure. Medicare Supplemental Plans along with Medicare Parts A and B normally offer many more benefits and freedoms than Medicare Advantage Plans. 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 and B

If you choose a Medicare Advantage HMO or PPO Fee For Service Plan, you will be dis-enrolled from Medicare Parts A and B.

Medicare will then pay a monthly premium to the Medicare Advantage plan to provide your health care. The plan may require you to pay an additional premium and may charge you a co-payment each time you go to the doctor or get a prescription.

To join a Medicare Advantage plan, you must have both Medicare Part A and B and not have end-stage renal disease. Also, not all plans are available in all areas of the state that you live in an area that has a plan.

3) You can have increased control over your choice of healthcare providers with Medicare Parts A and B alone rather than a Medicare Advantage Plan, even without a Medicare Supplemental (Medigap) Plan.

Medicare Parts A and B allow you to choose any 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. Medicare HMOs require you, in most instances, to use only physicians and hospitals in the HMO's network. You can generally go to any doctor or provider you want with a private fee-for-service plan you must find a provider that will treat you and accept the plans terms and conditions.

4) Medicare parts A and B alone (without a Medicare Supplemental) can provide you comparable benefits to Medicare Advantage Plans without restricting your ability to choose your healthcare providers or putting administrative restrictions on your physician for claim payments and referrals

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.

5) 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 that you can keep without giving up Medicare Parts A and B or your Medicare Supplemental (Medigap) Policy.

6) 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. For instance, if you needed treatment for colon cancer, for instance, they would have to allow you to see physicians and hospitals who treat cancer. However, if you chose to take advantage of the increase in survival rates demonstrated by a hospital or treatment center that specializes in cancer treatments and a 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 go to them and pay on your own, you will no longer have Medicare Parts A and B to fall back on. You will be responsible for 100% of all costs.

7) 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 Supplemental Plans and Medicare, however, are guaranteed renewable for life. You can never lose coverage as long as you pay your premiums. What's Important About Making Healthcare 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. Instead, you purchase insurance to ensure that, if and when health problems occur, that you will be able to recieve the best quality healthcare 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.

My reccomendations:

  1. Ultimately it is best to stay enrolled in Medicare Parts A&B and have a comprehensive Medicare Supplemental (Medigap) policy to pay the gaps that Medicare doesn't cover.
  2. If you cannot afford your Medicare Supplemental Policy, first shop around to make sure that you are paying the lowest premium possible. Enter your information above to request a Free Medigap Insurance Quote from Medigap360.
  3. Even if you can afford your current Medicare Supplemental policy, it is best to shop around to make sure that you are not paying more than you have to.
  4. If you still cannot afford Medicare Supplemental Insurance, do not enroll in a Medicare Advantage Plan. Instead, stay with Medicare Parts A&B. This will provide you access to choose any physician or hospital without delay. For the gaps that are left by Medicare coverage, you should be able to work out payment plans with your provider or find charitable programs to assist you . We have never heard of anybody who was not able to get the treatment that they need when they have Medicare Part A and B alone.
  5. Do not take a Medicare Advantage Plan just for Prescription Drug Coverage. Talk with a qualified and licensed Medicare Supplemental Specialists about your prescription drug insurance options including Medicare Part D.

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Brandon Todd is a Patient Advocate, a Licensed Insurance Agent and a Passionate Entrepreneur with a passion for creating unique and abundant win-win relationships.

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