Why I Would NEVER Choose Medicare Advantage

The Appeal of Medicare Advantage: Too Good to Be True?

Medicare Advantage plans are widely advertised as a zero-cost alternative to Original Medicare. With promises of extra benefits like dental, vision, and prescription drug coverage, it’s no wonder so many people are drawn to them. But as the saying goes, “If something sounds too good to be true, it probably is.”

Let’s peel back the cover and look at what’s really inside these plans.

The Hidden Downsides of Medicare Advantage Plans

1. Restrictive Provider Networks

Most Medicare Advantage plans require you to see doctors within a specific network. If you sign up for an HMO plan, you’ll likely need a referral to see a specialist. This means that not only are your healthcare options limited, but you also need permission to access certain types of care. If your preferred doctor is outside the network, you could be stuck paying out of pocket or switching providers altogether.

2. High Out-of-Pocket Costs

One of the biggest drawbacks of Medicare Advantage plans is the high maximum out-of-pocket (MOOP) costs. Many plans have an annual limit ranging from $5,000 to $8,000 or more. That means even though you’re paying little to nothing in monthly premiums, you could end up shelling out thousands for medical expenses when you actually need care.

These plans include:

• Co-payments for doctor visits
• Deductibles before coverage kicks in
• Co-insurance percentages you must pay for covered services

Unlike Medigap (Medicare Supplement) plans, which provide predictable costs, Medicare Advantage plans can surprise you with unexpected expenses.

3. Prior Authorizations: Delays and Denials

Another major issue with Medicare Advantage plans is prior authorization. This means that for certain treatments, surgeries, or procedures, you need to get approval from the insurance company before moving forward.

This process can delay necessary medical care and, in some cases, result in outright denials. If your doctor recommends a treatment but your plan denies it, you could be left scrambling for alternatives or paying out of pocket.

4. Limited Coverage When Traveling

Do you love to travel? If so, a Medicare Advantage plan could be a bad fit for you.

Most Advantage plans only cover emergency services outside your plan’s service area, which is typically your home county or state. This means if you spend part of the year in another location or frequently travel across the country, you may have difficulty finding covered medical providers. In contrast, Original Medicare with a Medigap plan allows you to see any doctor or hospital that accepts Medicare—anywhere in the U.S.

5. Plan Changes Every Year

Medicare Advantage plans change their benefits annually. That means the doctors in your network today might not be in-network next year, and the medications covered under your plan might suddenly become more expensive. Every year, you need to review your plan carefully to ensure it still meets your needs.

Many beneficiaries only realize a critical change has happened when they go to use their plan—when it’s already too late.

What’s a Better Alternative? Medicare Supplement (Medigap) Plans

So, if Medicare Advantage has so many pitfalls, what’s the better option? For many people, the best alternative is a Medicare Supplement (Medigap) plan.

Why Medigap Plans Are a Superior Choice

Medigap plans work alongside Original Medicare (Parts A and B) and help cover the out-of-pocket costs Medicare doesn’t, such as:

• Deductibles
• Co-pays
• Co-insurance

Agent Tip

Even if you miss your Initial Enrollment Period, you will still get the chance to sign up for Medicare Part C during the Open Enrollment Period, also known as the Annual Enrollment Period.

What’s the Cost?

Yes, Medigap plans come with a monthly premium, typically ranging from $80 to $200+, depending on your age and location. However, this predictable cost can save you thousands in unexpected medical bills compared to Medicare Advantage’s high out-of-pocket expenses.

Are There Any Drawbacks to Medigap?

Medigap does have some limitations, including:

• No built-in drug coverage – You’ll need a separate Part D prescription drug plan.
• No extra perks – Unlike Medicare Advantage, Medigap plans don’t include dental, vision, or fitness benefits.

However, the peace of mind knowing that your medical expenses will be covered is worth it for most people.

When Might a Medicare Advantage Plan Be a Good Fit?

While I strongly recommend Medigap for most people, there are a few situations where Medicare Advantage might make sense:

• If you can’t afford the monthly premium for a Medigap plan.
• If you’re healthy and rarely visit the doctor, meaning you likely won’t rack up many medical expenses.
• If you’re comfortable with networks and out-of-pocket costs, and are used to HMO or PPO-style insurance plans from employer coverage.

For those individuals, a Medicare Advantage plan could be a viable, albeit riskier, choice.

Final Thoughts: Choose Wisely

At the end of the day, choosing between Medicare Advantage and Medigap depends on your personal healthcare needs and financial situation. However, based on my experience helping thousands of clients, I would NEVER choose a Medicare Advantage plan for myself.

The hidden costs, restricted networks, prior authorizations, and lack of flexibility make these plans a poor choice for many seniors. If you want stability, predictability, and true nationwide coverage, a Medicare Supplement plan is the way to go.

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Still unsure which plan is right for you? Give us a call at Bluewave Insurance at 800-208-4974, and we’ll help you find the best Medicare coverage tailored to your needs.