Why is Medicare Advantage so Difficult?

Medicare is one of the most extensive health care insurance plans in the U.S., with millions of beneficiaries across the country. There are a lot of complications when trying to understand Original Medicare. Medicare Advantage adds even more detail and complexity.

Why is Medicare Advantage so Difficult?
Photo by Austin Distel on Unsplash

Understanding Medicare Advantage

Medicare Advantage should offer people the same benefits as Original Medicare (above all else), but it does not have to provide said benefits in the same manner. 

With Original Medicare, beneficiaries still have to pay 20% of most medical costs upon reaching their yearly deductible. Or, they can decide to buy Supplement Insurance (also called Medigap) to cover some of the other expenses involved.

Medicare Advantage plans, though, can determine specific deductibles for patients, and it can choose its own:

  • Coinsurance amounts
  • Co-payments
  • Deductibles

It may seem like a huge ‘pro’, but it is difficult for beneficiaries to truly assess which option is better for them. This is because different healthcare services can have varying costs, making it difficult to determine the plan's actual cost making it easy to miscalculate their budgets.

Additionally, the Medicare Advantage plan's beneficiaries need treatment from a registered health professional (doctor). The doctor needs to be in the network plan,  which works well for older adults since they usually have a few different ailments. Thus, it's good to have one doctor who is aware of all the conditions.

Moreover, the limitation can also make it difficult to get instant treatment in cases of an emergency, and beneficiaries have to switch to conventional treatment options. Conventional treatments can cost thousands of dollars on average.

On the other hand, the Original Medicare plan allows users to choose any doctor for treatment, and the Medicare plan pays up to 80% of the total treatment cost.

The Kaiser Family Foundation data analysis claims that most Medicare Advantage enrollees have to pay more out-of-pocket costs for stays longer than 7 days. However, people with the Original Medicare plan may not face this issue.

Common Myths about Medicare Advantage:

Following are the common myths about Medicare Advantage and the  corresponding truth:

Myth: Enrollees in Medicare Advantage lose their Medicare Original membership 

Truth: enrollees get to keep their original membership as well

Myth: Medicare Advantage is the same as other supplementary plans 

Truth: Medicare Advantage replaces Original Medicare while Supplemental insurance works together with Original Medicare as it ads or “supplements” the coverage

Myth: The Medicare Advantage plan is too expensive 

Truth: The Medicare Advantage plans could cost as little as zero per month in addition to the Part B premium

Myth: All Medicare plans are the same 

Truth: Each medicare plan provides different benefits for the patient's needs

Myth: Medicare can change your plans without informing you

Truth: Medicare needs to inform subscribers about plan changes before implementing them

What Makes Medicare Advantage Difficult?

Medicare Advantage is required by law to provide all the services covered by Original Medicare (both Part A and B). However, Medicare Advantage plans are allowed to limit access to services for budget control and require getting referrals and preauthorization for treatments. That is why it might not always be easy to understand Medicare Advantage properly – there’s a lot to check and a lot to review with each plan. 

Bottom Line

Choosing Medicare Advantage over the Medicare Original may seem like a good idea. However, most benefits of the Advantage plan have technicalities and loopholes. It is best to consult with experts to determine the best plan options. You can check Hella Health for more info which will help you decide what to do. 



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