The biggest downside to Medicare Advantage plans is their lack of freedom and high out-of-pocket costs. You could spend thousands of dollars on coverage that far outweighs what you would pay if you enrolled in a Medicare Supplement plan and considered the monthly premium.
Disadvantages Of Medicare Advantage Plans
What are the biggest drawbacks of Medicare Advantage plans? They have more restrictions on which doctors and hospitals you can use than Original Medicare with a Medigap plan. Let’s look at 7 of the most popular reasons.
A Medicare Advantage plan’s biggest drawback is that most have networks. This means your program is most likely structured around a specific local region. This can be a real issue if you need to see a specialist outside your network.
- Want an example?
- What if you were diagnosed with cancer and the best cancer hospital in your area is out of network? You’re out of luck!
- My parents live in Port Richey, FL and have Original Medicare with a Medigap Plan. If either of them were diagnosed with cancer, they would immediately look for one of the best cancer hospitals in Florida — for example, the Mayo Clinic in Jacksonville, FL.
- They wouldn’t be able to get treatment at the Mayo Clinic because it would be out of their Medicare Advantage plan’s network.
- Imagine their shock, frustration and anger that the quality of their care will be determined by a plan’s network. This situation is easily avoided with Original Medicare and a Medigap Plan because there are no networks.
Do you hate getting a referral for any specialist you want to see?
That’s exactly what is needed with many of these plans. With these plans, you will choose your primary physician for your general care and may require a referral for specialists.
- Want to see a cardiologist? You’ll need a referral.
- Want to see an orthopedic doctor? You’ll need a referral.
- How about an Endocrinologist? Get a referral
- Neurologist? Referral!
Does getting a referral for specialists sound stressful and a major inconvenience? If you said yes, then a Medicare Advantage plan may not be the right choice.
Nearly all enrolls are in plans that require prior authorization for some services.
- You make an appointment with your primary physician.
- You get a referral to a specialist inside your network.
- You make another appointment to the specialist.
- You’re finally at the appointment to diagnose and treat your condition.
That’s when you find out that your specialist may need to get prior authorization before the test, service or medication is approved.
At this point you realize that your doctor’s test, service, or medication may get denied!
- You’ve probably seen many commercials talking about all the free Medicare Advantage plans around the country.
- With MAPD, you’re going to pay something for any medical visit. This can be in the form of a copayment and/or coinsurance.
- Those free plans can quickly get very expensive.
Out Of Pocket Maximums
Unlike Original Medicare, this plan has an out of pocket maximum (MOOP). This can be a good thing because you potentially only have to pay up to the maximum amount before all your covered medical costs are paid for.
Original Medicare with a Medigap plan is predictable. The coverage is the same from year to year. Same Medicare doctors and same Medigap plan benefits.
- This is not the case with Medicare Advantage coverage.
- Every year you will need to shop plans and make sure your preferred doctors are in the plan’s network. To make matters worse, providers (hospitals and/or physicians) can leave a Medicare Advantage at anytime during the year.
Choosing a Medicare plan can be extremely confusing. It’s even more confusing when you mix in complicated plans such as Medigap or Medicare Advantage.