Top 10 Disadvantages of Medicare Advantage Plans | Teska’s Top 10

Number 1:  Annual Changes.

With Medicare Advantage Plans, your medical and prescription drug benefits change annually.  You'll have to review your options carefully. Each insurance company's plans will likely differ from other companies’ plans.  This includes company-specific rules, what they charge and what they provide. Not all plans are available in all states, and the specifics change annually.

Number 2:  No Guaranteed Renewals.

Medicare Advantage Plans are not guaranteed renewable.  They can be - and are - canceled with less than 60 days’ notice. For example in Florida in 2014 when a popular Massachusetts plan called Physicians United Plan was declared insolvent, and people were called by doctors who canceled their appointments because the plan could no longer pay the claims of its policyholders.

Number 3:  Networks, Referrals, and Travel.

Typically, you must use providers and doctors within a specified network. Referrals for services are also commonly required.  Medicare Advantage Plans are NOT travel-friendly. You may experience difficulty getting emergency or urgent care due to rationing.  Plans can limit care approvals to control paid claims. The plans only cover certain doctors, often drop providers without cause, breaking the continuity of care.  Obtaining healthcare services while you’re traveling can be difficult.

Number 4:  Out-of-Pocket Costs.

Medicare Advantage plans often come with high out-of-pocket costs, deductibles, co-payments., which can make budgeting difficult, especially for those on a fixed income.

Number 5:  Limited Flexibility.

It’s difficult to switch to other types of plans.  You’re subject to enrollment and dis-enrollment periods, as well as health restrictions.  If you’re unable to pass the health underwriting qualifications of for example a Medicare Supplement plan.

Number 6:  Difficult to Comparison Shop.

Difficult to compare and shop as plan benefits are not standardized and vary greatly company to company

Number 7:  Give Up Your Right to Original Medicare.

You must give up your right to Original Medicare.  If your doctor decides not to accept your Medicare Advantage Plan, you can’t just bill Medicare for the services provided.  For people on a fixed income, this creates significant uncertainty and limits their ability to budget accurately.

Number 8:  You get what you pay for.

Typically, the worst aspects of Medicare Advantage Plans won’t become evident until you’re already sick.  The out-of-pocket costs related to serious illness are frequently through the roof for plan beneficiaries!

Number 9:  Empty Benefits.

The extra benefits offered with an Advantage Plan can turn out to be less than promised.  Some of these “empty benefits” include gym memberships, hearing and vision benefits that are often less than what's expected of a policyholder.

Number 10:  Lots of Paperwork.

Expect to do a lot of paperwork if you decide to go with a Medicare Advantage Plan. Some plans - and some providers - make you file your own claims. Not only does this require your time, but it also means you’re responsible for any up-front costs.

In this episode of "Teska's Top 10," Rick Teska of Senior Market Solutions lists 10 disadvantages YOU should know about Medicare Advantage plans. From annual changes to lots of paperwork, Rick highlights the biggest disadvantages to expect with a Medicare Advantage plan. At Senior Market Solutions, we help thousands of Medicare beneficiaries save money on Medicare and Medigap.

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