Over the years, I’ve written many times about problems that could come up for consumers after they agree to be covered by a Medicare Advantage plan. Medicare Advantage are widely hyped by insurance companies so the information you see in ads isn’t often helpful.
Medicare Advantage combines Original Medicare and a supplemental or medigap policy. The plans are offered by health insurance companies. Federal payment are received each month for each person to manage Medicare benefits for recipients. You only receive one statement instead of two if you have a medigap policy.
Open enrollment is underway with a closure date of Dec. 7.
Figuring out the best option for Medicare coverage is a complicated process.
Medicare Advantage companies often offer lower premiums and extras not covered by Original Medicare such as dental, exercise programs, and eyeglasses.
However, you could end up paying more for medical expenses, your providers may be limited, and you may be denied treatment, even treatment provided under Original Medicare.
An article in The New York Times does a good job getting into the details of Medicare coverage in the article “Medicare Advantage vs. Traditional Medicare: What You Need to Know.” (The article is behind a paywall so to read it you can subscribe, set up an account to be able to read a certain number of articles, or read it through your local library.)
The article points out that Medicare Advantage plans:
- Offer more limited provider networks. The plans can change their list of in-network providers at any time.
- Are likely to have higher out-of-pocket expenses. This is a concern for people who need a lot of care.
- Have complicated rules for when and if you can switch to a medigap plan if your Medicare Advantage plan isn’t working for you.
Finding a good plan continues to be difficult.
Contact your state insurance commissioner’s office to get in touch with your state’s State Health Insurance Assistance Program, or SHIP, office. It provides free help to Medicare beneficiaries who have questions or issues with their health insurance. You can call a counselor to help you compare policies or to attend a workshop/presentation in your area.
Be sure to get help to compare policies if you’re going to buy a new medigap policy or switch. Medicare Advantage salespersons don’t have your interests at heart. They just want to make a lot more money.
