Medicare Advantage Plans have gotten a tough rap over the past few years. One prominent website that sells Medigap plans practically rails against Advantage plans (like HMO's and also PPO's). The owner of the site goes so far as for you to say that Medicare receivers nearly always be better off with Original Medicare (Part A and also Part B) than with a Medicare Advantage Plan. The reason why are some people so vocal in their opposition to these plans? Here are several reasons why I do think this is the condition.
1. Many unscrupulous agents have sold Medicare Advantage Plans without really considering what was in the best attention of the Medicare beneficiary. Stories have abounded about "grandma" being rolled over into some new plan that did not really include her doctor or medication.
I have personally been in the kitchen with Medicare Beneficiaries who were crying, mainly because some fool agent preferred making a commission to helping that person get what the best plan for their situation.
The good news is, Medicare along with CMS (the Center for Medicare along with Medicaid Services) have clamped down hard on these kinds of activities. The bad news is, you can find still a host of agents (as well as agencies) who are still engaged with this sort of nonsense.
2. Low and Even Zero Plan Premiums Can be Misleading
Many Medicare Advantage Plans have very low or even zero plan premiums. Many folks see this as well as think that they are acquiring something for not a single thing. The truth is on the other hand, definitely not that simple. Co-pays, Co-insurance and higher drug costs with many of these plans can actually cost more than premiums for a Medigap policy.
In addition in order to this, as we have been looking at some of the plans for 2010, you will find some plans that have no out of pocket maximum (no stop loss, if you will). If you end up acquiring really sick with some of these plans, you might be responsible to pay a huge sum of money for your share of your health-related costs.
3. Restrictions for you to Networks as well as Plan Rules
Another gripe often leveled against Medicare Advantage plan is that Medicare Receivers are restricted for you to seeing only providers that are approved by the plan. In an HMO (Health Maintenance Organization) for example, you must normally decide on a Primary Care Physician (PCP) and if you want for you to see a specialized, you must get a referral from your PCP before you do so.
With all of those "strikes" against Medicare Advantage Plans, perhaps you are expecting me in order to say, along with that other author I mentioned, that Medicare Advantage Plans are never the suitable choice for people with Medicare.
That on the other hand is not really the situation. You can find many situations we have encountered where it appears at least (in our judgment) that a Medicare Advantage Plans is in the best benefit of a client and also does offer you better protection than Original Medicare (Part A & Part B) alone.
You will find many, many, many people who absolutely, favorably, under no circumstances, cannot afford in order to pay a monthly premium (for a Medicare Supplement Policy and also or a Prescription Drug Plan).
I am of the opinion that if you CAN afford for you to pay a premium for Medigap as well as a Part D Plan (and it does pay in order to shop around) that you should pay the premiums as well as be done with it. If you cannot afford it even so, there may indeed be plans that provide protection over and also above Original Medicare (plans for example that provide a comprehensive Maximum Out of Pocket, or MOOP).
Are Medicare Advantage Plans right for everybody? Obviously not. Just as there is definitely not one retirement plan, or life insurance plan or long term care plan that is not necessarily proper for every person, there is simply no way to say that Medicare Advantage is "best" or that a Medigap policy is "best."
It is nevertheless, too simplistic in order to say that Medicare Advantage is never in the best benefit of a Medicare Beneficiary. Medicare Advantage Plans may have gotten bad press (for a variety of valid reasons), but these plans, in my opinion are a still a good choice for many people.
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