Medicare Advantage plans

By April 29, 2014 January 3rd, 2020 Making the Most of your Medicare

We get clients asking us all the time about $0 premium plans, which are called Medicare Advantage plans.  Below is a list of the major issues with Medicare Advantage plans

–          Advantage plans limit the number of doctors and hospitals you have access to. We suggest you call all your providers before enrolling in a plan.

–          Medicare Advantage plans utilize something called Prior Authorization, which means that the provider must get approval from the insurer before a service is covered.  If the insurance company disagrees with the doctor, a service may not be covered.

–          If you are a diabetic you may be paying 20% for your supplies.

–          The plans are not guaranteed renewable, meaning they can leave you without coverage if they decide not to renew in the future. Medicare Advantage Plans only sign an annual contract with the government, which is subject to federal funding.  If the funding is cut the plan may decide to stop offering coverage.

–           Are you on a Medicare part B covered drug?  These are generally medications administered at a physician’s office, i.e. infusions or implants. Medicare Advantage plans generally leave you with a 20% copay.

–          Do you use an internist or specialist as your Primary Doctor?  This can cause issues with HMO plans that require a gatekeeper for referrals.  You may be tasked with switching doctors or finding a doctor to refer you to your internist.

Generally people who sign up for a Medicare Advantage plan see the $0 monthly premium and not the monthly copays or the hoops these plans can make you jump and your doctor jump through to get the care you need. When making the tough choice between Original Medicare and a supplement vs. a Medicare Advantage plan, you must look at all your out of pocket cost, not just the $0 premium.

Eric Steinlage  AKA Blogasarus rex

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