Why do some people regret choosing a Medicare Advantage plan over Original Medicare?
Answered by 11 licensed agents
If your health situation has dramatically changed, some people may wish they had a Medicare Supplement plan - usually due to choice of physicians or healthcare facilities, as Medicare Advantage plans are network driven. And it is important to note that even though your PPO plan allows you to 'see any provider of your choice,' that provider still has to agree to seeing you out of network. So that can be problematic in some cases and make them wish they had chosen a Med Supp plan. Both types of plans have their advantages and disadvantages, and it is important to understand the differences between both before making your own healthcare decision.
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!
First you have to stay enrolled in Medicare to have a Medicare advantage plan. It’s just that the advantage plan pays instead of Medicare. I don’t see much regret for advantage plans. I’m on one myself and I’m very happy with it. There is no perfect plan so what do people not like? Sometimes their doctor is maybe not on the plan, some approvals are needed but that’s the same under group insurance plans. The thing I don’t like myself is that Part B drugs you pay 20%. This is expensive and in that year you would hit your maximum out of pocket. But good plans? Yes.
There are a few different reasons why people regret going with a Medicare Advantage plan vs Original Medicare. They don't realize the full cost of what they could pay year after year on a Medicare Advantage plan. The Maximum Out Of Pocket (MOOP) on most plans are over $7000 and if you are dealing with some major health concerns you could pay that for multiple years. The other reason is on a Medicare Advantage plan, you have to make sure your Dr's are in network and the Dr's can drop in and out of network year after year.
Medicare Advantage requires you to utilize a specific provider network for your care. You do not have the freedom to go to any physician and any hospital and health system. Also, Medicare Advantage requires pre-approval of many medical procedures. Also, depending on your health issues, you may have significant out-of-pocket expenses. And if you want to leave Medicare Advantage and change to traditional Medicare with a Medicare Supplement (medigap), you may be denied because of a pre-existing condition.
I don’t know! MA plans are helpful if you are staying local with no travel; your doctor accepts the plan now, and it pays your Part B, and your Prescriptions. But what is the Co- Pay, the deductibles, and Maximum Out-of-pocket costs? But you have NO CHOICE OF DOCTORS, No COVERAGE when you travel as you are OUT OF NETWORK, and cannot see the specialist facilities such as Moffett, Mayo, and the Cleveland Clinic. You give complete control of your health to a group of individuals to decide IF you can see someone and cover you.
We have quite a few people who have had advantage plans and have become ILL. The copays, coinsurance, large out of pocket expense have caused these people to rename them to Disadvantage Plans. Agents really like to sell Advantage Plans, as the compensation is quite a bit more that of Medigap plans.
There could be several reasons, one of which is a change in the doctor and hospital network. If a member's doctor or hospital is suddenly not in their advantage plan network, then their care can be disrupted. Another reason may be that the member gets ill and incurs more copay costs than they are used to and wishes they had more coverage. A Medicare Supplement covers more medical costs as compared to an advantage, though for an additional premium. These are risks that an Advantage plan member needs to take into consideration, going into an advantage plan with their eyes wide open, knowing that no one has a crystal ball to predict the future.
Even if you regret choosing a Medicare Advantage plan, you MIGHT be able to go back to Medicare with a Medicare Supplement. Timing, health, and your state of residence can all play a part in determining what is possible. With Medicare Advantage, network problems and medication/doctor changes might require a plan change which may result in different levels of benefits and costs. It's usually a "package" deal, to fix one thing you might break another, which is not common but definitely can be difficult to deal with as a consumer. To me, it's fun helping people figure things out!
Limited provider network, higher out of pocket costs, referrals and authorizations, plan changes year to year, traveling in and out of state.
Because these issues often only become apparent after someone enrolls, many people don’t realize the limitations until they need care that isn’t covered or are faced with high out-of-pocket costs. It's essential to compare all your options carefully to ensure the plan you choose aligns with your health needs and preferences.
