About half of all Americans that choose additional Medicare coverage will go with an Advantage plan. While these plans work well for many people they are not without their flaws. Today, let's dive into the top 3 disadvantages of these plans. 

Benefits of Advantage Plans

Now before we go into the three downsides of Advantage plans, I think it's fair to first examine why so many buy these plans for a bit of context. 

Low Premiums

First, people like Advantage plans for their low monthly premiums. Many Advantage plans actually have no monthly premiums, and those plans that do have a premium have a very low monthly premium. In fact, one of the highest premiums for an Advantage plan might be somewhere in the ballpark of $49/month. So for many people, this is an appealing incentive. 

Perks

Second, many people choose Advantage plans because of all the added perks.  Advantage plans will throw in perks like dental benefits and vision benefits, gym membership coverage, and even hearing benefits that cover hearing aids. Supplemental plans generally don’t add in these types of things, so many people choose an Advantage plan for the benefits of these added perks. 

Three Disadvantages of Advantage Plans

Despite these perks and lower premiums, there are some downsides to Advantage plans. Let’s talk about the three main disadvantages. Keep in mind, we’re not trying to steer you away from going with an Advantage plan (they can be a great option for some people), rather, we want you to have all the information so you can make your own choice. Unfortunately, many agents aren’t upfront and honest about the negative side of Advantage plans, so many people purchase the plan without having all the necessary details. We’re here to change that.

Networks

The first downside to Advantage plans is the network system. When you go on a Supplemental plan Medicare is your only network. This means you can go to any doctor, hospital, or healthcare provider who accepts Medicare. Advantage plans are a bit different. With an Advantage plan, you are required to stay within a specific network (either an HMO or PPO network), of doctors and health care providers. While many hospitals and doctors are within one of the Advantage plan networks, not all of them are, so you are limited when it comes to choosing a health care provider. 

Now if you choose a PPO Advantage plan, you are allowed to go to a doctor or hospital out of the network, but you will have to pay extra for it. 

Pre-Certifications

The second downside to Advantage plans is pre-certifications. What are pre-certifications? Let’s say your doctor says you need a CT scan or even a hip or knee replacement. If you’re on an Advantage plan your doctor will have to call the insurance company and get you pre-approved for the procedure or test. The insurance company may approve the hip replacement, or they could deny surgery and first require that you undergo physical therapy first before approving a procedure. 

Now, not everything has to be pre-certified with an Advantage plan. For instance, you can go to your primary care doctor or to a specialist all you want without having to go through the per-certification process. But for certain procedures and tests the insurance company, not your doctor, will have the final say. 

In fact I recently had a lady that needed a hip replaced. She was on an Advantage plan and her insurance company said she had to go to therapy for nine months first, and if she still needed the hip replaced after that then they would reconsider.  

Another client of ours recently needed an MRI because of his chronic back pain. Since he’s on an Advantage plan, he had to go through the pre-certification process to get approved for the MRI. His insurance denied him the MRI and told him to go to therapy for three weeks, and afterward, they would reevaluate. So as you can see, if you go with an Advantage plan, the insurance company, not your doctor, has the final say. 

If, on the other hand, you go with a Supplemental plan, there is never a pre-certification requirement. If your doctor says you need a procedure or test, you can get it done, no questions asked. 

Switching Plans

The third and final disadvantage to Advantage plans is their switching policy. Every year, Medicare has an open enrollment period from October 15th to December 7th. Most people think that during this open enrollment time they can switch to whatever new plan they want without any problems. Unfortunately, this is not true if you’re on an Advantage plan. 

Let's say you’re on an Advantage plan but would like to switch to a Supplemental plan. The problem is, if you’ve been on the Advantage plan for one year or more, you have to be approved by the insurance company to make the switch. You’ll be asked a series of 20 to 25 health questions, the insurance company will need to check all your medications to see what you’re being treated for, and they’ll require a statement from your doctor. Unfortunately, if the underwriter doesn’t qualify you, you won’t be able to switch to a different plan.

Conclusion

As you can see, there are several benefits to getting on an Advantage plan, like added perks and lower monthly premiums, but there are several disadvantages to the plan as well. First, you’ll be limited to which doctors and hospitals you can choose from, you’ll have to get pre-certified to have certain procedures and tests done, and if you want to switch to a Supplemental plan in the future, you’ll have to medically qualify. 

If you are interested in learning more about Advantage plans please click here to read our article on how to choose the best one. Instead, if you are now more curious about Supplemental plans we have you covered. Simply click here to learn more about Supplemental Plans.

As always, if you would like some free assistance in choosing the right option for you our Medicare School Guides would love to help. They help people each day decide which option is best and can even help you enroll right over the phone. Find a time to speak with a Guide today, or give us a call at (800) 864-8890.

 

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MedicareSchool.com started in 2009 to provide an unbiased and education-focused service to individuals approaching Medicare enrollment. Since then, MedicareSchool.com has helped over 100,000 people find and enroll in the best Medicare plans that fit their budget.