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Misconceptions About Medicare Advantage Plans- A Question and Answer Session

Over the last thirty-five years, we’ve talked to thousands of Medicare beneficiaries about Medicare and their insurance.  We’ve heard it all quite frankly.  From the horror stories of denied coverage to the successful transitions to the Medicare program in general.  Year after year though as October 15th looms and Medicare’s Annual Open Enrollment is set to begin, that’s when the storytelling becomes larger than life.  Unfortunately, there is a lot of misinformation passed on this time of year to unsuspecting beneficiaries, we find the information is most common to the marketing of Medicare Advantage plans.  We’re setting the record straight this week and addressing some of the misconceptions that we often must address with the folks we talk to this time of year.

“I’m Still on Medicare.”

If you are on a Medicare Advantage Plan, you are not covered by Medicare A and B.

How SMS can help:  Medicare Supplement plans work in tandem with original Medicare, meaning your medical expenses can be covered at 100%.

“My Medical Needs Are Covered.”

Under Medicare Advantage plans, claims for medical and surgical procedures, primary care visits, specialist visits, home health care, physical therapy, and prescription drugs are frequently denied.

How SMS can help:  Any doctor or hospital that accepts Medicare will accept your Supplement plan, and any procedure, service, or therapy your doctor recommends will be covered by Medicare.

“My Coverage Is Clearly Outlined.”

Without federal standardization, Medicare Advantage insurers have wide discretion in determining coverage. Medicare Advantage policyholders frequently express concerns about gaps in coverage and hidden costs they were not made aware of upfront. Coverage information is not readily available or easily explained.

How SMS can help: Each Medicare Supplement plan has clearly defined federally standardized benefits.  Our customers easily review the costs and benefits of each plan before selecting the plan best suited to their needs.

“I Can Choose My Doctor.”

Medicare Advantage covers a limited network of doctors, hospitals, and nursing facilities. Your approved list of providers will change year to year, potentially leaving you with fragmented care. Finding care while traveling will be difficult.

How SMS can help: Supplement plans cover any provider who accepts Medicare.  Your coverage goes where you go, giving you the freedom to travel good in all 50 states.  Some Supplement plans even provide limited medically necessary emergency care outside the country.

“I’ll Save Money with Medicare Advantage.”

While most Advantage plans have low premiums, out-of-pocket maximums range from $4,000-$9,000. Patient costs of Medicare Advantage plans can easily climb higher than those of combined Medicare and Medigap coverage.

How SMS can help:  Medicare Supplement’s low monthly premiums allow customers to plan financially.  Without hidden costs, our customers enjoy peace-of-mind, knowing exactly how much their care will cost when health issues inevitably arise.

 “I’m Covered in An Emergency.”

Medicare Advantage beneficiaries commonly complain about denied benefits during an emergency or urgent care.  On top of a health crisis, customers are hit with enormous out-of-pocket costs.

How SMS can help: A Medicare Supplement plan ensures coverage wherever Medicare is accepted, including emergency facilities.

“The ‘Affordable Care Act’ Won’t Affect Me.”

As a result of changing health care laws, Medicare Advantage plans have been de-funded. Premiums are increasing, benefits are decreasing, and doctors are leaving networks. Changing benefits leave Medicare Advantage patients with less coverage while they scramble to find new providers.

How SMS can help: Medicare Supplements are not annual contracts.  The government has standardized each plan for simplicity, guaranteeing the same benefits year after year.

“I Can Switch to A Medicare Supplement Whenever I Need To.”

If your health declines while you are a Medicare Advantage customer, you risk becoming ineligible for a Medicare Supplement plan.  Medicare Supplement plans require the insured to pass medical underwriting.

How SMS can help: Senior Market Solutions contracts with over twenty-five major insurance carriers, each with different eligibility requirements.  Let us help you find a plan to meet your needs, regardless of your current health.

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