If you have been following MedicareInc.com for any period of time, you will know that we strongly advise most of our clients against enrolling in Medicare Advantage plans. Recent news has even pushed us to further discourage seniors from entertaining the idea of a Medicare Advantage plan.
So what exactly has happened? Medicare Advantage charges a maximum out-of-pocket limit when you sign up for the plan. This rate has skyrocketed just recently. Let’s take a look at what Medicare Advantage is and the problematic charges that some seniors are discovering right now.
What is Medicare Advantage?
Medicare Part C, also known as Medicare Advantage, is a program provided by private insurance companies approved by Medicare. To qualify for Part C, you must already be enrolled in Medicare Part A and Part B, and live within the service area of the desired Medicare Advantage plan. You cannot enroll in Advantage and Medigap simultaneously.
Medicare Advantage plans usually provide more coverage than Original Medicare (Part A and Part B) and may include prescription drug coverage, which Original Medicare does not provide. Some Medicare Advantage plans do not include drug coverage, and Medicare generally does not allow those enrolled in a anAdvantage Plan to also be enrolled in a stand-alone Medicare Prescription Drug Plan.
Most Advantage Plans cover all Medicare-related services, and some offer additional coverage for routine vision, dental, or prescription drugs through participating providers within the plan. However, these providers may not necessarily be your preferred doctor or facility. Medicare services are covered through the an Advantage Plan and not under Original Medicare, but Part B premiums must still be paid.
Enrolling in Advantage plans may require monthly premiums, annual deductibles, copayments, and coinsurance, and out-of-pocket costs may vary. Different rules may apply for obtaining services, such as needing a referral to see a specialist or being required to use specific doctors, facilities, or suppliers within the plan for non-emergency or non-urgent care. In most cases, care cannot be received outside of the network unless it’s a hospital emergency. These rules can change each year, and they can discontinue care due to doctors, hospitals, and specialists leaving networks.
What is the Maximum-Out-Of-Pocket Limit?
Medicare Advantage on the surface may seem like a great deal. Oftentimes the monthly premium is zero and you get a few extra benefits not covered by Original Medicare or Medigap. However, have you ever thought about how an Advantage company makes a profit? If you are not paying a monthly fee, how do they make money?
The answer is simple. They charge a yearly maximum-out-of pocket limit. What does this mean? It means that when you go to use your Medicare Advantage plan, you may have to shell out thousands of dollars after your visit. Now, the Advantage company will point out that there is a limit. In 2023, the limit was raised and now sits at $8300! That means in any given year, you could dole out $8300 if you have to use your Advantage plan. It could be less, but it still could reach those limits! It was previously set at $6700.
Where is the Advantage?
We like to ask time and time again: where is the ‘advantage’ when it comes to Medicare Advantage? With an Advantage plan, you could pay $8300 per year alongside copays, co-insurance, and more. You are limited to a network and the discretion of the advantage company to determine if your medical procedures will be covered at all.
Now you might be wondering, well what about the dental, vision, and hearing that is covered by my Advantage plan? If you investigate your benefits further, you will realize that not a lot is actually covered by a dental, vision, and hearing plan through anAdvantage plan. Typically, they cover routine check-ups and that is about it. You might get dental cleaning twice a year, but anything beyond that will cost you.
Final Thoughts
It is safe to say that if applicable, you should enroll in Medigap. At MedicareInc.com we strongly advise against enrolling in Medicare Advantage plans. Our friendly brokers are available to help you navigate through Medicare and enroll in a Medigap plan. Call today! (480) 382-1823.
