Medicare Advantage plans might seem like a bargain because they have more features and lower premiums. But there’s a downside to these plans too, most of which we don’t see until it’s too late. From having fewer doctor options to paying more out of pocket, these can complicate managing your healthcare more. Make sure to know the downsides before signing up so you can choose what’s right for your health and wallet. Let’s look at some of the issues that you might experience with Medicare Advantage.
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Limited Choice of Doctors and Hospitals
Medicare Advantage coverage usually comes with a network of physicians and hospitals. You may have to change providers or pay a higher premium if your favorite doctor or specialist isn’t in this network. This can be frustrating, especially if you’ve been going to the same doctor for years. Unlike Original Medicare, where you can go to any doctor that accepts Medicare, these plans feel restrictive.
Referrals and Prior Authorizations Are Often Needed
Most Medicare Advantage plans require you to receive a referral from your doctor before going to a specialist. They can also request prior approval for some treatments or procedures. That’s a bit of extra work, wait time, and hassle, especially if you urgently require care for something health related.
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Coverage Can Vary by Location
Medicare Advantage plans are typically region-specific. If you are moving out of state, you may no longer have coverage or will have to change plans. That’s not ideal if you live in different states and frequently move around. In contrast to Original Medicare, which is a nationwide plan, these plans will leave you with unexpected gaps in coverage.
Out-of-Network Care Can Be Expensive
If you require care outside of your plan’s network, it will be more expensive. Sometimes, the plan will not cover the service at all. It can be a nightmare when you have an emergency while traveling or the expert for your disease is not on the network. Expenses for out-of-network coverage add up quickly.
Plans Can Change Every Year
Each year, rules, coverage and provider networks can change for Medicare Advantage plans. That can mean your expenses, benefits or doctor network could be different from when you signed up. You’ll have to go over your plan every year to see if it works for you, which is extra work.
Extra Benefits Might Not Be as Good as They Seem
A lot of Medicare Advantage plans list additional benefits, such as dental, vision, or hearing coverage. But those benefits usually have restrictions such as low limits on spending or the providers you can use. A dental plan, for instance, might only pay for a regular cleaning but not expensive procedures. These extras are not going to save you much money.
High Out-of-Pocket Costs Are Possible
Medicare Advantage plans are usually cheaper than Original Medicare but have a high out-of-pocket expense. You can be charged more for co-pays, coinsurance or deductibles, especially if you need to get care often. Some have a cap on your out-of-pocket costs, but these caps are sometimes quite high, leaving you with hefty bills.
Emergency Care May Be Limited
Even though Medicare Advantage plans must cover emergency services, what constitutes an emergency varies. If your plan rules an emergency wasn’t really one, you could end up paying for it. It can leave you confused about where and when to go in a health emergency.
Prescription Drug Coverage Can Be Complicated
Most Medicare Advantage plans cover prescription medications but the list of drugs covered (formulary) may vary each year. You’ll need to use another medication or shell out the difference if your medication is taken off the list. Plan can also have tiered pricing where some drugs cost significantly more than others, even if they are for the same condition.
Switching Back to Original Medicare Isn’t Always Easy
If you want to switch back to Original Medicare from Medicare Advantage, there are a few issues that could arise. Medigap plans, for instance, which provide supplemental coverage to Original Medicare may reject your application or charge you more depending on your health. This can make it difficult to switch plans if your healthcare needs change.
Disclaimer: This list is solely the author’s opinion based on research and publicly available information.
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