There is a lot of talk and no shortage of data on the pros and cons of Medicare Advantage (MA) plans, the private-plan alternative to traditional Medicare. These are often referred to as Part C or “pay-as-you-go” plans.
You can turn on your TV at any hour of the day or night and see numerous ads with famous people promoting Medicare Advantage plans. While meeting over coffee with Medicare-eligible friends, everyone is comparing benefits. What plan do you have? Why doesn’t my plan cover that? What is the best option for my needs? The truth is, your concerns are unique to you, so there is not a “cookie-cutter” answer for finding the right option.
The marketing for Medicare Advantage plans is a big business. So, when TV commercials say you will pay nothing for your plan, remember that with any option the premium is taken out of your monthly social security check (unless you are eligible for Medicaid by your state, in which the premium is paid on your behalf). When you choose a Medicare Advantage plan you give up traditional Medicare benefits.
According to The New England Journal of Medicine, more than one-third of the Medicare population is choosing Medicare Advantage Plans.* A big appeal is the added benefit of gym memberships, dental, hearing and vision coverage.
It’s easy to think the “grass is greener” on another person’s plan, but take a look at the specifics and your unique needs. Before making any change regarding coverage, ask all your questions and make sure they are answered. As a health advisor, I serve as your advocate to help you walk through all the options and potential pitfalls of traditional Medicare vs. Medicare Advantage. Companies are spending a lot of marketing money to get your business, so make sure you know what you are and are not getting.
For example, traditional Medicare Part B gives you the freedom to choose providers and travel anywhere in the US. If you enjoy traveling or live part of the year in another state, this is a good option. For a 5-day hospital stay, half of all Medicare Advantage enrollees incur higher costs than beneficiaries in traditional Medicare, and nearly all Medicare Advantage enrollees are in plans that require prior authorization for some services.
Medicare Advantage (MA) plans include HMOs (Health Maintenance Organizations), PPOs (Preferred Provider Organizations) or HMO-POS (HMO-Point of Service). With an HMO, you are provided a network of physicians and are required to see your Primary Care Provider for referrals. A PPO allows you to choose your physician and see a specialist without referrals. HMOs remain the dominant plan, including those with POS (point of service) options to go outside your network but pay more out of pocket.
Enrollment in Medicare Advantage has doubled in the past decade, and the marketing of these plans has increased exponentially.** Medicare-eligible beneficiaries enjoy having options, so free gym membership and having everything in one place are desirable benefits.
In 2020, most Medicare Advantage enrollees were in plans operated by UnitedHealthcare, Humana, or BlueCross BlueShield (BCBS) affiliates. Medicare-eligible beneficiaries enrolled in Medicare Advantage continue to climb with 42 percent enrolled in a Medicare Advantage plan in 2021, up from 32 percent just five years ago.***
Medicare Advantage premiums have dropped, and in 2021 seniors will have more plans to choose from due to a 76.6 percent increase since 2017. This year 4,800 plans will be available with a rise in plan choices per county and in rural areas.****
The Open Enrollment Period for Medicare Advantage and prescription drug plans (PDPs) runs from October 15th through December 7th each year. This season creates a wealth of options as individuals enroll for the coming year. The competition for your health dollars is getting more competitive as health insurers offer new pricing and options.
The sources at the end of this article give you plenty of data if you want to read more. If you are approaching 65 or you just have questions about your options, a personalized appointment is recommended. There is plenty of buzz about Medicare options, and a health adviser can walk you through the process at no cost to you. Call today for a free consultation to learn about your options.
*** Medicare FFS enrollment data from CMS, January 2018–January 2021. https://www.chartis.com/as-medicare-advantage-enrollment-booms-healthcare-entities-need-to-plan-around-key-trends