Is Medicare Advantage Really an Advantage?

That depends.  In the throes of Medicare enrollment period, we are being bombarded with Medicare Advantage advertisements touting its benefits. According to an August 2023 study done by Kaiser Permanente, in 2020 Medicare Advantage covered more than 44% of enrollees or 25.7 million people with Medicare. This number is only increasing: the same study found that in 2023, 51% or 30.8 million of all the Medicare eligible population were Medicare Advantage participants.

Traditional Medicare, MediGap plans, Medicare Advantage…what’s a 65+ year old to do? Given the fact that 63% of working individuals continue to enroll in the same health insurance plan every year, it is certainly tempting to do the same thing every year here. Sadly, older people most often face increasing health issues: doctors, medication, treatments to name just a few. Knowing how to select a plan and which plan will be best is a mystery to many.

There are a myriad of factors that come into play when making this decision. It would be impossible to discuss every issue to consider. Here are some of the most common, and probably important components:

  • Consider all the current medical services you use. Doctors, therapists (both physical and mental) and prescription drugs need to be assessed. Although studies say that 90% of doctors take Medicare, this just isn’t true in major metropolitan areas. While they may take Medicare, they may not take Medicare Advantage, which may have a more limited network where you live,
  • If you’ve been covered by private insurance, you will likely find that the coverage was better than Medicare, even with a MediGap supplemental plan addition or Medicare Advantage. If you used an out-of-network provider, you may have been reimbursed based on a percentage of what was thought of as “reasonable and customary”. If your doctor doesn’t accept Medicare, you will need to file a claim and an appeal with Medicare to try to get any reimbursement. This is a very long and cumbersome process.
  • Prescription drugs can present an even greater challenge. This is especially true of dermatological creams. If you see it on television, it is doubtful that it will be covered by any Medicare prescription drug plan. If you were covered by a private insurance drug plan, you may have been able to get drugs for a minimal copayment, as little as $10. Medicare Part D plans are not considered private insurance drug plans. There is a possibility of financial assistance through drug companies, but you will need to meet income requirements to qualify. Be sure to look at this carefully.
  • Premiums for Medicare Advantage are frequently less than pairing traditional Medicare with a MediGap supplemental plan to cover what Medicare doesn’t cover. Medicare Advantage may also include dental, hearing, drugs, and gym memberships. Depending on the Medicare Advantage plan, there may be no premium. Keep in mind, however, there are network and other restrictions that may apply.

This is just a short list of questions to ask yourself. If you start here, you will find that there are probably more things to consider when you select a Medicare plan. Most importantly, these plans and your own health change from one year to the next. Examine your options carefully.