Medicare Advantage plans have some drawbacks. Your choice of providers may be more limited, and you're much more likely to need prior approval to receive expensive care. Medicare Advantage (MA) plans are designed to cover everything covered by Original Medicare (Medicare Part A and Part B), in addition to prescription drugs and eye, hearing or dental care, all in exchange for a low premium. However, compared to Original Medicare, Medicare Advantage plans have some disadvantages. Your choice of providers may be more limited, you're much more likely to need prior approval for expensive care, and your plan may change unexpectedly.
By any measure, traditional Medicare is a better option for patients, doctors and taxpayers. Beneficiaries may pay lower premiums up front with Medicare Advantage, but later on they may be burdened by high cost-sharing, more limited provider networks, and outright denial of the burden of care they wouldn't have to bear if they had enrolled in traditional Medicare. You can get a supplemental plan, or Medigap, that provides you with the coverage that you want at an affordable price. The 20 percent of health care costs not covered by traditional Medicare can add up quickly.
Supplemental plans, offered by private insurance companies, cover some or even all of what Medicare doesn't cover. In general, the higher the premium, the stronger the coverage. If you get sick and don't have supplemental coverage, you may have to pay thousands of dollars in out-of-pocket costs, says Hoadley. You automatically re-enroll each year and, if you wish, you can switch to a different add-on plan at the time of open enrollment.
The law requires that Medicare Advantage plans be at least equivalent to the coverage you would get with Original Medicare. Most plans include Part D prescription drug coverage, plus additional benefits, such as dental, eye, hearing and fitness memberships. Think about how your care needs may change over time. If you have a chronic condition or expect frequent doctor visits, you may want to lower initial costs and a maximum out-of-pocket limit with Medicare Advantage. If you travel frequently, a flexible plan may be more important than additional benefits, such as dental and eye care.
The best option depends on how you plan to use your health plan.
