Medicare Advantage Plans - Pros and Cons


No one type of Medicare Insurance plan fits everybody the same. What may work best for one person, may not work very good for another person. It is a personal choice for you to decide, but it is important to get all the facts first before making a decision. However it is also important to pick the correct plan that fits your needs, since not all Medicare Advantage plans have the same benefits. It is important to review the Summary of Benefits before picking a specific plan.

If you currently have health insurance, you probably already have some similarities of a Medicare Advantage plan, such as a PPO or HMO plan. There are some major differences as well.

Medicare Advantage plans are administered through private insurance companies and not through the government like Original Medicare is.

I’ll start with some of the Pro’s of a Medicare Advantage plan and then list some of the Con’s.


Pro’s

  • Many Medicare Advantage plans have a $0 monthly premium!
  • Many Medicare Advantage plans do not have a Medical deductible!
  • Many Medicare Advantage plans include drug coverage in the same plan with no additional monthly premium.
  • Medicare Advantage plans have to give you at least the same (or more) Part A and Part B benefits than what Original Medicare allows you for Part A or Part B benefits.
  • Medicare Advantage plans may include additional benefits that Original Medicare and/or Medical Supplements may not, such as:
    • Dental Benefits
    • Vision Benefits
    • Hearing Benefits
    • Fitness Memberships At Gyms
    • Nurse Helplines (Available 24 hours a day & 365 days a year)
    • Heath Screening Tests
    • Over The Counter (OTC) Benefits
  • All Medicare Advantage plans have a Maximum Annual Out Of Pocket Limit
  • Emergency Room coverage within the U.S., even if out of network.
  • Medicare Advantage plans cover Urgently Needed and Emergency Services Worldwide! (Original Medical generally doesn’t cover emergency services out of the U.S.) 
  • Medicare Advantage PPO plans allow you the flexibility to go out of network, but you will pay more to do so. However if you stay in-network, generally you will have lower costs.
  • Some plans allow you to travel in other states and still be covered in-network.
  • Medicare Advantage plans generally try to keep the emphasis on heather living and preventive care.
  • Medicare Advantage plans must enroll any eligible beneficiary who applies regardless of health. (Starting 2021 - Including those with ESRD!)
  • Some Medicare Advantage plans may cover additional days of hospitalization vs Original Medicare.
  • Some Medicare Advantage plans may cover skilled nursing and rehabilitative services without a prior 3 day inpatient Hospital stay. 


Con’s

  • Most Medicare Advantage plans have a network of doctors.
    Note: HMO’s require you to use a provider in-network or you are NOT covered. (With the exception of a true emergency. All Medicare Advantage plans cover true emergencies, even if out of network.) PPO plans have more flexibility allowing you to go out of network, but you will pay more if you do.
  • Your favorite doctors possibly may not be in-network. That is why it is important to make a list of your doctors and have your agent look all of them up in the specific plan you choose before enrolling. That way you shouldn’t have unpleasant surprises later in the year.
  • You need to be living in a Medicare Advantage plan service area in order to enroll in a specific Medicare Advantage plan. If you move out of that service area later, you will be required to change plans.
  • You are required to be enrolled in Part A and Part B in order to be enrolled (and stay enrolled) in a Medicare Advantage plan. So you will still need to continue to pay Part B premiums to the government.
  • Not necessarily a con, but just like stand alone Part D plans, Medicare Advantage plans that include drugs have a formulary. (A formulary is a list of drugs covered under that specific plan.) If your drugs are not included in their formulary for the plan you choose, they won’t be covered. So it is important for you or your agent to check in advance to make sure all your drugs are covered and estimate how much each will cost.
  • Most Medicare Advantage plans have copays, co-insurance, and possibly deductibles. So you kind of pay as you go. 
  • Generally, unless you have a special circumstance that qualifies you for a Special Election Period (SEP) you can be locked in for one year in the plan you chose.



Note: Medicare Insurance information can be overwhelming and confusing to many people. As an independent licensed agent I can explain things to you in simple terms so you feel comfortable making a decision. Then I can help you choose and enroll in a plan that you feel fits your needs.

By the way, it doesn’t cost you any more if you enroll in a Medicare Insurance plan through me as an independent agent versus directly with an insurance company either over the phone or via the Internet, since I get paid by the insurance companies for your enrollment. Plus you will have personalized service by a local agent. If you would like my assistance, please call me at 941-404-5334.

By calling this number, I understand I will be directed to a licensed insurance sales agent.

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