Medicare Questions & Answers: Medicare Advantage
Medicare Advantage Q&A
Showing 66 questions
Are Medicare Advantage plans really "free," or is that just clever marketing?
The concept of "free" Medicare Advantage plans can be misleading. While some Medicare Advantage plans advertise $0 monthly premiums, it's crucial to understand that this doesn't mean you won't have any healthcare costs. Here's a breakdown:* $0 Premium Doesn't Mean $0 Cost:
A $0 premium means you don't pay a monthly fee to the private insurance company offering the Medicare Advantage plan. However, you'll still likely have other out-of-pocket costs, such as:
* Co-payments: Fixed amounts you pay for specific services (e.g., doctor's visits, prescriptions).
* Coinsurance: A percentage of the cost you pay for services.
* Deductibles: The amount you pay before your plan starts covering costs.
Contact at 859-309-5033 if you would help with your Medicare Planning
What's the trade-off between a Medicare Advantage PPO and HMO when it comes to flexibility?
An HMO limits your services to a closed network of physicians and caregivers. HMOs require members to choose one of their in-network primary care physicians to manage your healthcare, and require a referral approval to use other in-network services. HMOs generally do not allow any out-of-network services unless it's an emergency.PPOs are more flexible with their network of services and do not necessarily require a primary caregiver. You can use services outside of their network of treatment services, and you will still be covered. However, PPOs generally have higher prices, deductibles, copays, and coinsurance when you use services outside of their network.
What is the biggest disadvantage of Medicare Advantage?
Medicare Advantage plans do have some great benefits, but some things to keep in mind are:Medicare Advantage plans has specific doctors and hospitals in their network, so these plans are network based.
Prior Authorizations are needed for some services, which can cause some delay in necessary care.
It's important to check each year to make sure your doctor is still in the network, as this can change from year to year.
Is Original Medicare or Medicare Advantage better? Why do you recommend one over the other?
It will be different for everyone.Original Medicare lets you see any doctor that accepts Medicare and pairs well with a Medigap plan to lower out-of-pocket costs, but it doesn’t cover dental, vision, or prescriptions.
Medicare Advantage bundles everything, often with extra benefits like dental and vision, but you have to stick to a network of doctors.
If you want flexibility, Original Medicare with Medigap is usually better. If you prefer an all-in-one plan with lower upfront costs, Medicare Advantage might be the way to go.
Do Medicare Advantage plans really save seniors money in the long run? Why or why not?
Medicare Advantage plans can potentially save seniors money in the long run, but the impact varies by individual circumstances. They often have lower premiums and may include additional benefits not covered by Original Medicare, such as vision and dental care. However, these plans might have higher out-of-pocket costs for certain services and often require members to use a specific network of providers. It’s important for you to evaluate their healthcare needs and compare costs before choosing a plan.
Can I switch from a Medicare Advantage plan to a Supplemental/Medigap plan during the Annual Enrollment Period without answering health questions?
The short answer is no. However, there are always exceptions such as a Special Enrollment Period (SEP) to make a change or within your 12-month trial right period, or you are involuntarily terminated from your Medicare Advantage plan due to moving out of the plan service area, gaining eligibility due to age (turning 65), to name a few. In these cases, I want to discuss the change and ensure we cover all available SEP options.
I have Original Medicare, and I'm wondering if I'd save more on my dental cleanings if I switched to a Medicare Advantage plan instead.
Yes you can save money on dental cleanings if you switch to a Medicre Advantage plan. Most Advantage plan include $0 copay for cleanings, x-rays, preventive care, and extraction.
My diabetes medication is super expensive, and I've heard horror stories about Part D not covering what people need. Should I go standalone Part D or get it through a Medicare Advantage plan?
I am diabetic and I am on a Medicare Advantage plan. Insulin costs are capped at $35/mo. Other meds, like Ozempic, are not inexpensive, but they are available.
My Medicare Advantage plan advertised dental coverage, but it barely covers anything. Is this normal?
Dental coverage like most coverages vary from company to company and plan to plan. When sitting down with your Medicare or Health Insurance Broker, be sure to mention any services you hope to have done or coverages you’d like to make sure you have. This way, your Broker can find a plan that is tailored for your needs and expectations.
I picked a PPO for the flexibility, but now every time I go out of network the bills are outrageous. What's the point of even having a PPO?
I totally understand your frustration!Having a PPO (Preferred Provider Organization) plan is supposed to give you flexibility and freedom to choose your healthcare providers, both in-network and out-of-network. But, when the out-of-network bills start piling up, it can be overwhelming.
The point of having a PPO is to have access to a wider network of providers, including specialists, without needing a referral. However, it's essential to understand that out-of-network care usually comes with higher costs.
To avoid surprise medical bills, it's crucial to:
- Carefully review your PPO plan's network and coverage
- Verify the network status of your healthcare providers
- Understand the out-of-network costs and billing procedures
If you're feeling overwhelmed or unsure about your PPO plan, I'm here to help!
As a licensed health insurance broker, I can guide you through the complexities of Medicare and health insurance. Let's work together to find a solution that fits your needs and budget.
Call me today at 407-244-6951 to schedule a consultation. Let's navigate the healthcare system together and find a plan that gives you the flexibility and affordability you deserve!
Why might Original Medicare with a Part D plan be better than a Medicare Advantage plan for frequent travelers?
It really isn't since original Medicare only pays 80%, the member is responsible for 20% of everything which can become costly. and you have to PAY for Part D every month & pay for your medication. A Medicare Advantage Plan includes drug coverage with Tiers 1 & 2 usually $0 costs , depending g on the plan
Isn't it concerning that Medicare Advantage plans are taking over the system?
Medicare changed very little in it's first forty years and that is a bad sign in any program or product. Demand for better service and a better product drives competition between the companies that provide Medicare Advantage plans. This competition makes for a better product for all Medicare recipients that are part of the Medicare Advantage program.
My mom is considering switching to a Medicare Advantage plan because her friends say it's better. She's scared of losing her current doctors. How can we check?
One, no one should ever pick a plan because their "friends" say it's better. I cannot tell you how many people made that mistake. Medicare insurance needs are different for everyone.Two, she should be concerned about her doctors accepting the insurance because Medicare Advantage plans are network plans. But that is why you have me as a broker to check all the networks to make sure your doctors accept the plan you may be switching to.
What is the trap of Medicare Advantage plans?
Prior authorization! This has nothing to do with your doctor or your agent but with your insurance company. There have been a greater # of insurance firms that now will question whether a less expensive treatment for your malady may be used instead of the first one prescribed by your Primary Doctor. Moreover, you likely know that an Advantage plan has no monthly premium as it is subsidized by the Federal Govt. As a tradeoff to that, it does contain a fairly steep deductible which again, depending upon the State you live in and the policy of your insurance company, can be a burden for those with not much money. This is why it is essential to fully understand the differences between a Med. Supplement (with a premium) and a Med. Advantage plan. The cheapest premium does not always offer the best benefits!Remember this: at 65, you're likely to be healthier than you will be in 5 or 10 years. So, just because you may run 3 miles a day, doesn't mean that you can keep that up when you're 75!
Why are people unhappy with Medicare Advantage plans?
Did you know that approximately 50% of the Medicare population has Medicare Advantage? Popularity for this type of coverage is surging. Still, Medicare Advantage is not for everyone and there aren't too many things that we're all happy about. I think it's a lack of understanding that causes displeasure with Medicare Advantage. As a Medicare Advantage member myself for the past 5 years and having sold these products for 18 years, I am 100% happy with Medicare Advantage considering the thousands of dollars I have saved by using Part C. So what's the problem with Medicare Advantage? Have you talked with your agent and gained a full understanding of Medicare Advantage and how it works? Medicare Advantage plans, many of which feature $ 0 (zero) monthly plan premiums, have deductibles, copays and coinsurance depending on the plan. All Medicare Advantage members are protected by an out of pocket maximum which varies depending on plan and service area. This is in exchange for higher premiums associated with traditional Medi-gap or Medicare supplement plans. It's important to take the time to learn about these products before making an enrollment decision.
Why is regular Medicare better than an advantage plan?
There's a lot of confusion with Medicare-Medicare Supplement/Medigap/-Medicare Advantage "alphabet soup"! Do your homework and learn the Pros and Cons of each Option! Work with someone -like ME-who can offer both: Medicare Supplement/Medigap and Medicare Advantage plans! This was you get the FACTS not the HYPE and then make the best decision for YOU! :) WE can HELP!How can I verify if a Medicare Advantage plan's advertised benefits are legit?
CMS, Centers for Medicare Services, overseas the Medicare Part C Advantage program. By law, Medicare Advantage plans must be at least as good as Medicare, which is to say that all plans are better than original Medicare. CMS will shut down any plan advertising benefits that are not real. "They've got your back!"Why do some agents push Medicare Advantage plans over Medigap-should I be skeptical?
If you have an agent who pushes any certain plan you should be skeptical, and the said agent is probably not looking out for your best interest. No one plan is perfect for everyone. You need to know the differences between Original Medicare and Medicare Advantage plans and how they could affect your healthcare.If I move to a rural area, how might that limit my Medicare Advantage plan options?
Again, Medicare advantage works off of networks and generally the rural areas have less providers available in these networks.
How do you explain to clients that "zero-premium" doesn't mean "zero-cost" with Medicare Advantage?
Benefits vary from plan to plan. Often times you may have a $0 copay with an in-network primary care physician, for example. There is usually cost sharing for out-patient surgeries, hospitalization, major diagnostic tests as well as other services. Cost sharing can be a set dollar amount or a percentage of the cost.
What shift has been observed in Medicare spending, particularly regarding Medicare Advantage plans?
Some plans which were in place in 2023 and 2024 have had their Maximum Out Of Pocket (MOOP) increase in 2025.
I need a hearing aid but I've heard Medicare doesn't cover them. Is there any way around this?
Original Medicare (Parts A and B) does not include Hearing Aid Coverage. Medicare Advantage often times does but not all plans so check closely on the plan if you are enrolled into Advantage. Supplement plans typically do not include Hearing Aid coverage but may include a discount plan or a rider for purchase with certain carriers (in certain states only).I picked a Medicare Advantage plan based on the low premium, but now I'm facing high copays. Did I make a mistake?
Probably not. Premiums are long term, co-pays are short term. The cost of Medicare Supplement premiums are often thousands per year and will always go up. You will always pay them, whether you use the plan or not. On the other hand,you will only have copays when you use the services, and servies are often not long term. Part B medications like chemotherapy often have a 20% copayment but it is short term. Durrable Medical Equipment like an oxygen concentrator would also be 20% and is probably long term, but it's about $30 per month.When you join a Medicare Advantage plan with low premiums, I always suggest using your new savings on the cost of your prior health plan to build yourself a little savings account. If you have $2,000-4,000 saved, you will never worry about copayments. Planning and budget make all the difference.
If you are really worried about the copays, talk to your agent about options to move to a Supplement. If you are healthy it is usually not a problem. There are also guaranteed acceptance plans if you are not healthy.
My neighbor says I'm crazy for paying for a Medigap plan when Medicare Advantage is "free." What should I tell him?
I help folks in Michigan and after your initial enrollment into medicare here, you will have to health qualify for medigap(supplemental) plans. With our health you never know what is around the corner. If serious health issues wiping out your savings is a concern...and it should be. Medigap plans are the safest option.
My Medicare Advantage plan covers dental, but I can't find a dentist who accepts it. Is this a common problem?
Yes, not all plans use the same carrier for dental, and some differ between HMO and PPO. However they all have a provider search tool that we can assist with.My kids keep telling me to get a Medicare Advantage plan, but my friends say stick with Original Medicare. Who should I listen to?
Someone who deals with helping clients with Medicare planning every day! Get the facts-not the hype! Work with someone who can explain the "medicare alphabet soup" so it's easily understandable and who also sells both: Medicare Supplement/Medigap AND Medicare Advantage! We can go over all the Pros and Cons of each plan and with staying with Original Medicare!Don't you think Medicare will eventually be privatized completely?
This is a considerable debate among Medicare beneficiaries and our government. The possibility of prioritizing Medicare is happening through the Medicare Part C Advantage plans, known as managed care under the supervision of major insurance companies. However, it is in the individual's choice to choose which direction they're going with Medicare. As Medicare Advantage plans continue to improve their services and networks of managed care, we will see more and more individuals moving in that direction.Suppose traditional Medicare Part A and Part B, with a Medigap plan, offered similar services like dental, hearing, and vision coverage to Medicare Part C advantage plans. In that case, they may not be as attractive. Traditional Medicare does not have in-network services, so you can use your benefits anywhere that they will take Medicare.
What's the best way to compare my current Medicare supplement plan to a Medicare advantage plan?
I always tell my clients to count up the cost. Write down all the out-of-pocket cost to have a Medicare Supplement plan and what your cost will be if you sign up for a Medicare Advantage plan. If you would like to discuss and compare plans, you may give Melissa Barton a call at 473-242-8437.I chose Original Medicare to keep my doctors, but now I'm drowning in bills. Should I have gone with Advantage instead?
Original Medicare and no other coverage is a major mistake because you will be on the hook for 20% of all outpatient charged services with no limit. Medicare Advantage plans are all different but one thing they have in common is something called an Out of Pocket Maximum which will limit your financial exposure every year.
My Medicare Advantage plan listed my doctor, but now they say he's out of network. How is that even allowed?
That can be frustrating! Medicare Advantage plans typically have contracts with specific networks of doctors, hospitals, and other healthcare providers. However, sometimes these contracts change throughout the year. Even if your doctor was in-network when you enrolled in your plan, they might have been removed from the network later due to changes in the insurance company’s agreements or policies.Unfortunately, this can happen, but you do have some options.
I picked a Medicare Advantage plan because of the dental and now I found out it only covers cleanings. Why didn't anyone tell me this upfront?
Most Medicare advantages cover more than cleanings. If you worked with a broker you needed to ask them how the dental works and what they will Cover. You can also call me and I can adviseDo Medicare Advantage plans save money?
The question of whether Medicare Advantage plans save money is complex, with varying perspectives. Here's a breakdown of key considerations:Potential Cost Savings for Individuals:
* Lower or Zero Premiums:
* Many Medicare Advantage plans offer low or even $0 monthly premiums.
* Out-of-Pocket Maximums:
* These plans typically have a limit on your annual out-of-pocket expenses, providing a degree of financial protection. Traditional Medicare lacks this cap.
* Additional Benefits:
* Many Medicare Advantage plans include benefits not covered by Original Medicare, such as dental, vision, and hearing care, which can lead to cost savings if you utilize these services.
* Consolidated Coverage:
* Medicare Advantage plans often combine Medicare Part A, Part B, and Part D (prescription drug coverage) into a single plan, streamlining costs.
Concerns About Overall Costs:
* Higher Costs to the Medicare System:
* Reports, such as those from the Medicare Payment Advisory Commission (MedPAC), indicate that Medicare Advantage plans can cost the Medicare system more than Original Medicare. This is due to factors like how the plans are paid, and coding intensity.
* Potential for Hidden Costs:
* While premiums may be low, Medicare Advantage plans can involve copayments, coinsurance, and other out-of-pocket costs that can accumulate.
* Prior Authorizations and Network Restrictions:
* Medicare Advantage plans often require prior authorizations for services and have network restrictions, which can limit access to certain providers and potentially lead to unexpected costs.
In summary:
* For some individuals, Medicare Advantage plans can offer potential cost savings through lower premiums and added benefits.
* However, from the perspective of the overall Medicare program, there are concerns that these plans may increase costs.
* It is very important for an individual to carefully review the details of any medicare advantage plan they are considering.
Why would you not choose a medicare Advantage plan?
Medicare Advantage plans can be beneficial, but they come with certain limitations. These plans restrict your healthcare providers or services under the PPO (Preferred Provider Organization) and HMO (Health Maintenance Organization) networks. You often need preapproval for about 70% of procedures under a Medicare Advantage plan. You must have a preferred Physician as your primary physician, and a referral from your primary care physician is required to see other specialists in or outside your network.It's important to note that these plans are often designed with specific geographic areas in mind, which may limit your access to available providers outside of your local area. However, Medicare Advantage plans offer many additional services that traditional Medicare with Medigap plans may not provide, and they cover your prescription drug plans with zero to low monthly premiums. Medicare Advantage plans are only good for one year and must be renewed yearly.
What's the key difference in how Medicare Advantage and Medigap handle out-of-network providers?
Medicare Advantage often ties you to a network—go out-of-network, and you’re either paying more or not covered at all, unless it’s an emergency, which I’ve seen trip up clients who didn’t check their plan’s rules. Medigap, paired with Original Medicare, doesn’t care about networks; any provider accepting Medicare works, giving you flexibility I’ve found folks appreciate when they travel or need specialists. It’s a clear-cut distinction that hits home when you’re picking between the two.I signed up for a Medicare Advantage HMO, and I'm wondering if I can see a cardiologist out of network without paying everything myself.
HMO stands for Health Maintenance Organization and is a type of plan that requires you to see doctors in its network. If you see a doctor outside the network, you will be responsible for all of the costs. The only exceptions to this are medically necessary emergency or urgent care services.
I have Medicare Advantage with a PPO, and I'm curious if my annual wellness visit is free or if I'll owe something for it.
Your plan more than likely will have a zero dollar co-pay for your annual wellness visit however, it’s always a good idea to double check your summary of benefits to make sure.
I picked a Medicare Advantage plan last year, and I'm not sure if my hearing aids are covered. How do I figure this out?
1. Call the member services phone number on the back of your card, and inquire as to how the hearing aid benefits work with your specific Advantage plan.2. or, call the Agent/Broker who helped you enroll in the Advantage plan. He or she should be able to give you the main points of the hearing aid benefits and then point you to phone numbers for third party contractors who provide the hearing aid benefits to this plan.
3. or, obtain the EOC (Evidence of Coverage) pdf document that outlines in detail how all the benefits work, for your plan.
As a senior, what should I know about the differences between Original Medicare and Medicare Advantage before I choose?
Basic Original Medicare by itself covers Part A (hospital stays) and Part B( doctor visits). You usually pay a monthly Part B premium, which is paid by Social Security Administration from your benefits, and you must meet yearly deductibles. Original Medicare will then cover 80% of the approved amount, and you're responsible for the remaining 20% of the cost of care. There is no limit to your out-of-pocket cost each year. You may need a supplemental insurance plan to cover 20% of the cost of care and prescription drug coverage.
Medicare Advantage plans are more comprehensive plans that support your entire well-being, so you can live a better, healthier life. You usually pay a monthly Part B premium, which is paid by Social Security from your benefits.
In one package, it gives you Part A and Part B coverage, plus Part C coverage.
Many plans also include Part D prescription drug coverage. It has limited out-of-pocket cost, It has more predictable co-pays, and a cap to your yearly out-of-pocket expenses.
Should there be stricter regulations on Medicare Advantage marketing and sales practices?
The regulations on Medicare Advantage marketing and sales practices are already very strict, so no, I don't believe they should be stricter. That could potentially limit the good information that an agent can share.
What should I do if I find out that my preferred hospital isn't in-network with my Medicare Advantage plan?
You can go to any doctor or hospital with Medicare Advantage. Although, there have been instances where a hospital drops the Medicare Advantage plan. You can switch plans during Medicare Advantage open enrollment, Jan 1 to March 31. If you can't find another plan to switch to, you could return to Original Medicare and you could also pair Original Medicare with Medigap.How is Medicare Advantage expected to evolve in the future?
Medicare Advantage is expected to soon be the more popular form of Medicare coverage. Enrollment for Medicare Advantage plans is growing and expected to continue to grow.Isn't it suspicious that Medicare Advantage plans offer gift cards and incentives to enroll?
They are not allowed to offer incentives to induce enrollments. I advise prospects and clients to be wary of offers like this.What is the biggest disadvantage of the Medicare Advantage plans?
The biggest disadvantage of the Medicare Advantage plans is the negative publicity surrounding the insurance, the negative sentiment and fake news making Medicare Advantage seem like a bad idea. As an independent Medicare agent for the past 18 years and a Medicare Advantage member for the past 5 years, I have no regrets and if I could do it all over again, would stick with Medicare Advantage. OK, there are plusses and minuses with Medicare Advantage but the program is overseen by the Federal Government. That's CMS, the Centers for Medicare Services. By law, Medicare Advantage must be "at least as good as" original Medicare. Medicare Advantage members are protected by an out of pocket maximum so that's probably the best thing about the program. On the flip side, many doctors don't like Medicare Advantage because it's more work for them. Some procedures require prior authorizations so the additional paperwork is not popular among the medical profession. But, I have yet to hear of a medically necessary procedure that has been denied by any Medicare Advantage plan.Why do some people regret choosing a Medicare Advantage plan over Original Medicare?
What we've seen in helping our clients with Medicare planning-is that when you go with a Medicare Advantage Plan -the Insurance company will make the decisions on what they will cover and not cover. Another important difference is with Original Medicare as long as your doctor(s) take Medicare you are covered -with a Medicare Advantage Plan-you'll be working with a PPO or HMO type organization and you NEED to make sure YOUR doctors are Part of that plan! Medicare Advantage plans change year to year too! We have several situations this year where Doctors who were prior a part of the network are NO longer in the network! Work with someone who can go over all the Medicare "alphabet soup" and who can offer both: Medicare Supplement/Medigap AND Medicare Advantage and can give you the Pros and Cons of both so YOU can make smart decisions!
What's your go-to strategy for helping someone decide between Medicare Advantage and Medigap?
I have a seven question algorythm that is 99% accurate. Seven questions and the appropriate strategy is evident.
Does Medicare Advantage cover home health care?
Yes, if your doctor orders it. However, Medicare does not cover 24-hour-a-day care at your home, home meal delivery, homemaker services (like shopping and cleaning) unrelated to your care plan, or custodial or personal care that helps you with daily living activities (like bathing, dressing, or using the bathroom), when this is the only care you need. Some Medicare Advantage plans include some homemaker services when returning home from the hospital, so ask your broker.Hey, I keep hearing about Medicare Advantage plans everywhere. What's the real deal with those compared to regular Medicare?
Original Medicare (OM) is a government administered 80/20 health plan. An Advantage plan covers some of the costs not covered by OM plus prescription drug, vision, dental and hearing coverage. Advantage plans are available at low or no monthly premium.
Why are hospitals not taking Medicare Advantage plans?
That is a contractual issue between the hospital and the insurance carrier. If they're not taking a Medicare advantage plan, they have their reasons for it. Typically if you stay with major brands you don't have that problem. It's when you get these small off-brand companies that are the ones that tend to Make it harder to find in-network hospitalsGet a Medicaid plan. You don't have to worry about any of that because because you're on regional Medicare and your Medicaid plan just pays the difference. If they take original Medicare they must take your Medicare supplement or medigap plan
Does Medicare Advantage cover acupuncture or alternative therapies in some plans?
Yes Some Medicare Advantage plans may cover Acupuncture. Always check your Summary of Benefits. The Acupuncture benefit could be covered for chronic low back pain only. Not all providers could be included.also See page 30 in your Medicare and You Handbook 2025
Can I keep seeing my current doctors if I switch to a Medicare Advantage plan, or do I have to find new ones?
You may or may not keep your current doctor's when switching to a Medicare advantage plan. Some HMO's and PPO's have extensive networks and your doctors may all participate. If you decide on an HMO you just stay in network. PPO's allow you to go out of network though your cost may be higher.What's the most misleading Medicare Advantage ad you've seen, and how do you explain the reality to clients?
Beware1 There are a lot of scams out there! Ads will offer you money or Flex cards. But when you click on the link they offer, you are asked for your zip code to see if you qualify. Guess what? Surprise! Your zip code does not qualify. But, since you`re here, why not enroll in my health plan? Beware!
What are the most overhyped benefits of Medicare Advantage plans that seniors should be wary of?
Benefits that are advertised nationally that only a super small percentage of the population (usually poverty level) qualify for. It's misleading for our senior population and creates confusion when there doesn't need to be any.
Don't you think Medicare should ban all those celebrity Medicare Advantage commercials?
I think it's their right to make commercials. If they are giving false information and misleading people to think that all plans come with $1,800 in grocery benefits every year, they need to make those things clear. I just make simple commercials and educational videos, which seem to work!
I exercise regularly and maintain a healthy lifestyle. Does Medicare offer any incentives or additional benefits for preventive health behaviors?
Health is important. That is why Medicare covers for preventive healthcare procedures to be more proactive than reactive.I'm confused by all the star ratings for Medicare plans. Do they actually mean anything for the care I'll receive?
The star ratings are real and based on customer feedback and experience with the different plans. As an agent, my focus is more toward plan benefits than star ratings but the star ratings are worth noting.
Why are seniors losing Medicare Advantage plans?
Seniors that are not paying for the plan if there is an additional cost is one reason they could lose their Medicare Advantage Plan. Also, if the carrier cannot sustain enough business in a county, the carrier can drop out of the area.
Why do doctors not like Medicare Advantage plans?
Doctors dislike Medicare Advantage plans due to administrative burdens, low reimbursement rates, and frequent denials of care, which impact their practice and patient care.What's the best way to avoid surprise bills for lab tests under Medicare Advantage?
When having lab tests done check with your Advantage plan agent or customer service center to ensure you are staying IN NETWORK! Also ask the medical provider ordering the labs if these are standard, common and preventative tests or if they are more rare. The insurance company can also help with pricing if they have all the information.
Do I need a Hospital Indemnity Plan if I have Medicare Advantage? What if I am hospitalized twice in the same year?
It's not necessary but you could face pretty high out of pocket costs.Advantage plans have deductibles and copays. The indemnity plan pays you a set amount by plan
My Medicare Advantage plan denied coverage for a specialist I need to see. What are my options now?
Your primary care physician may need to make the referral before its approved by your plan, especially if you have a HMO plan vs a PPO or HMO-POS plan where you can select specialists on your own instead of through your primary care provider. The other situation is the specialist you selected may not be in network. Again with HMO plans you always need to stay in network. With a PPO plan, you can choose a specialist who is not in network, but you will pay significantly more if you do. Check either with your agent or the customer service to find out what your options are to resolve this issue.My Advantage plan says I need a referral just to see a dermatologist. I thought PPOs didn't require that - was I wrong?
Just because a PPO allows you to go both in & out of your Advantage plan's network has nothing to do with referrals. You're confusing two different principles here. Also, bear in mind that I know the State of Arizona backwards & forwards. That means that there are likely some states where the answer given above may be different. It would make sense to check with your Medicare insurance company or your agent.
Is it better to get Medicare Part D or Medicare Advantage?
There really isn't a perfect answer to this question. It is based on what each person's needs and the how they want to be covered. The best choice really is an individual choice and how they look at their insurance needs and money they want to have to spend monthly on their insurance.More often Part D plans will have a higher Deductible and copay costs over a Medicare Advantage, so looking at each person's medications is a must when deciding on these plans.
How do Medicare Advantage star ratings affect the quality of care I can expect?
Generally, yes star ratings are an important factor when choosing a plan.Medicare rates plans based on their health and drug services from poor to excellent. (1 to 5 stars)
5 star rating is the highest/Excellent.
Star ratings are based on factors that include:
1. Feedback from members about the plan's service and care
2. The number of members who left or stayed with the plan
3. The number of complaints Medicare got about the plan
4. Data from doctors and hospitals that work with the plan
