What is the trap of Medicare Advantage plans?
Answered by 23 licensed agents
1. Some individuals may encounter difficulties when trying to switch back to traditional Medicare after enrolling in a Medicare Advantage plan, particularly due to their health conditions.
2. Medicare Advantage plans operate within provider networks, such as PPO and HMO networks.
3. Approximately 50 to 70% of surgeries or other therapies may require prior approval.
4. Coverage is subject to specific geographic areas, and you may need to obtain approval for services outside those areas.
5. Under Medicare Advantage, your out-of-pocket costs for one year of service could be significantly higher than with traditional Medicare combined with Medigap, especially if you have serious health conditions.
6. Medicare Advantage programs must be renewed each year, and the plans are subject to change annually.
Answered by Larry Dalton on April 29, 2025
Broker Licensed in OK & TX
Medicare Advantage can have coverage for Dental, Vision , hearing, Over the counter and healthy foods if you qualify.
Answered by Tasha Riggs on April 11, 2025
Broker Licensed in CO, AZ, HI & 10 other states
Answered by Lauryn Ivey on June 3, 2025
Broker Licensed in AL
That’s the benefit of having the Medicare advantage HMO plan, along with all of the other benefits that come along with dental, vision, hearing, chiropractic, acupuncture, over-the-counter benefits, so on and so forth.
Answered by Hope Suhr on May 22, 2025
Broker Licensed in CA, AZ, MO & OR, SC, TN & TX
Your doctor or hospital could disappear from your plan.
Provider networks are renegotiated every 1–3 years. That top-rated hospital or specialist you rely on? They could be out-of-network next year, and you’re left scrambling. If you live with a chronic condition, this can be devastating.
Chronic illness can drain your wallet.
If you're diagnosed with cancer, autoimmune disease, or need infusions or specialty drugs, you could hit the plan’s maximum out-of-pocket — up to $8,000+ per year depending on the plan — with no cap over time. And that's every single year.
You might lose your chance to find cost relief once you have a chronic illness.
Many people don’t realize you can’t just switch to a Medicare Supplement plan anytime. If your health changes and you now have pre-existing conditions, you can be denied a Supplement — and stuck in Advantage with higher long-term costs and fewer choices.
Bottom line: Medicare Advantage works for many — but it’s not risk-free. If staying in control of your care, costs, and providers matters to you, we need to talk through all the options first to understand the tradeoffs and your risk tolerance.
Answered by Yasmine Lopez on June 6, 2025
Broker Licensed in UT, AL, AZ & 17 other states
Answered by Lance Stanley on June 9, 2025
Broker Licensed in FL, AL, GA, MS & TX
In most states, you can only enroll into a Medicare Supplemental Plan WITHOUT having to go through underwriting during your initial, 6-month, Medicare Supplemental Plan 'Open Enrollment' window that coincides with the starting of your Medicare Pat B (Medical) coverage effective date.
Once that 6-month window closes, you can still change to ANY available Medicare Supplemental Plan available to you in your market at ANY time for ANY reason, BUT you are then beholden to underwriting guidelines (in most states) and you can be declined by the Medicare Supplemental Plan carrier that you're applying with if they deem you too high-risk to cover.
So, a common thing I run into is; someone starts out with a Medicare Advantage plan because they're attracted to the low (or $0) monthly premium and the extra benefits ("Advantages") that come with these Managed Care plans. Everything is fine until they get sick or start to deal with a serious or chronic health condition. They then experience ongoing copays and coinsurance costs which they are responsible for (up to their particular plan's Maximum Out of Pocket) and realize they are paying MORE for the low-monthly-cost Medicare Advantage Plan than they would be if they ha 100% coverage between original Medicare and a Medicare Supplemental plan that costs them a higher monthly premium.
There is no one-size fits all and there is quite a bit of nuance that can vary drastically, but generally speaking, if you can afford a Medicare Supplemental Plan, it will give you the better coverage long-term as you age and your risk profile increases.
Answered by Steve Thurmond on April 29, 2025
Broker Licensed in TN, AK, AL & 35 other states
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!
Answered by Steven Bleicher on April 16, 2025
Broker Licensed in AZ
Answered by DeeDee Whitlock on June 24, 2025
Broker Licensed in LA
Answered by Michael Crocker on April 18, 2025
Broker Licensed in SC
Answered by Mike Henry on July 2, 2025
Agent Licensed in TX
Answered by Suzanne Lamperti on July 4, 2025
Broker Licensed in MD
Answered by Robert Remin on June 9, 2025
Agent Licensed in NY, CT, FL & NJ
Answered by Eizel Mere on April 9, 2025
Broker Licensed in FL
We go through the important step of finding out what is important to you. Then we clearly explain the differences, the benefits, why people choose one vs the other and compare them to your priorities.
Many agents are not educated or appointed to provide you with many options. They try to fit you to the insurance company vs matching your needs with the plan the best aligns with them.
Answered by Wild Bill Anderson on April 14, 2025
Broker Licensed in CA
Answered by Robert Rowe on May 25, 2025
Broker Licensed in MI
Answered by Ellen Diehl on April 9, 2025
Broker Licensed in GA
Answered by Babs Atwell on May 1, 2025
Broker Licensed in OH
Answered by Judi Norton on April 9, 2025
Agent Licensed in NM
Answered by Louanne Allison on April 14, 2025
Agent Licensed in MI, FL, IL & OH, TN, TX & UT
Answered by Albert Smith on April 29, 2025
Broker Licensed in IL, FL, GA & 6 other states
Answered by Hector Vazquez on May 1, 2025
Broker Licensed in FL & TX
Answered by Christine Itami on April 9, 2025
Broker Licensed in AZ, FL, ID & 5 other states
Tags: Medicare Advantage
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