If you’ve been researching your Medicare plan options, you may have noticed Medicare Advantage Plans are often given a bad rap in articles and on social media.
However, you’ll also find that over 54% of people on Medicare choose to enroll in a Medicare Advantage Plan—more than any other plan type.
Why is that?
When you look at the online narrative against Medicare Advantage Plans, and then you see the generally positive satisfaction ratings, it can leave you confused.
And if they are so bad, why do more than half of the people enrolled in extra medical coverage still choose to enroll in a Medicare Advantage Plan?
In this article, we’ll help you see why Medicare Advantage Plans are still common despite what some people say about them online.
What Are Medicare Advantage Plans?
Medicare Advantage Plans are private health insurance plans designed to reduce your out-of-pocket expenses and provide additional coverage for Original Medicare. These Plans act as an all-in-one health plan for people on Medicare.
When you enroll in a Medicare Advantage Plan, Medicare pays your insurance company a fixed amount and transfers the responsibility of your healthcare to your insurance company.
Because of the way they work, Medicare Advantage Plans can have relatively lower premiums compared to other plan types. Many Medicare Advantage Plans even have $0 premiums.
Aside from typically lower premiums, Medicare Advantage Plans can also offer additional coverage because of the way they work.
Most Medicare Advantage Plans have built-in Medicare Part D prescription drug coverage, while many also have benefits for routine dental, vision, and hearing care.
Certain Medicare Advantage Plans even come with several perks like gym memberships, Flex Cards, transportation benefits, and more.
Why Do Some People Say Medicare Advantage Plans Are Bad?
If you listen to people on YouTube or social media, you’ll find that some of them attack Medicare Advantage Plans and try to push people towards enrolling in another type of plan—usually a Medicare Supplement Plan.
While there are some reasons why a Medicare Supplement Plan may be the better choice for you, you should be very careful around people biased towards one plan type.
This is because there’s often a money reason they’re trying to steer you one way over the other.
For instance, a lot of people who are criticizing Medicare Advantage Plans online are in fact not even licensed to sell Medicare Advantage Plans in the first place.
That’s right — there are a lot of reasons why it’s hard for agents to get a certification, but here are 2 of the big ones:
- For an agent to be able to sell a Medicare Advantage Plan, they must undergo a thorough certification process every year. Every year, they must pass several certification exams, which can take around 80 hours or more to complete.
- Agents selling Medicare Advantage Plans must also adhere to strict compliance regulations. For example, agents who say things like “Medicare Advantage Plans are better,” or “Medicare Supplement Plans are better,” will likely lose their license to sell Medicare Advantage Plans for pushing one type of plan above the other.
That’s why whenever you see someone openly saying, “Medicare Supplement Plans are better than Medicare Advantage Plans,” that should be an indicator to you that they are not licensed to sell Medicare Advantage.
Because they aren’t even allowed to say that if they’re licensed to sell Medicare Advantage!
7 Things to Consider Before Enrolling in a Medicare Advantage Plan
The truth is, while Medicare Advantage Plans are not “bad,” like with any other plan, there are several things to be aware of before enrolling in one.
No Medicare plan is perfect—each has its tradeoffs.
Below are seven things you need to consider before enrolling in a Medicare Advantage Plan.
#7: Copays and Coinsurance
Many people are attracted to Medicare Advantage Plans because of their low to $0 premiums. However, it’s important to also consider your share of costs for covered items and services.
Like Original Medicare, Medicare Advantage Plans have their own set of copays and coinsurance that you’re responsible for paying when you get covered services. Unlike Original Medicare, Medicare Advantage plans are not standardized, meaning each plan can set its own copays and coinsurance amounts.
That’s why, before enrolling in a plan, make sure to go over all the details, not just the premiums. You’ll generally find relatively low copays if you stay within the plan’s network.
#6: Drug Coverage
Most Medicare Advantage Plans have a built-in Medicare Part D prescription drug plan. These are known as Medicare Advantage Prescription Drug Plans (MAPD).
While not having to enroll in a separate Medicare Part D prescription drug plan can reduce hassle and costs, it’s important to note that you can’t separate a Medicare Advantage Plan from its built-in Medicare Part D plan.
If you find a Medicare Advantage Plan with great terms for your healthcare but the plan doesn’t cover your prescription drugs, you typically can’t enroll in the health plan and choose a separate prescription drug plan. Medicare Advantage Plans are generally “bundle” plans.
When choosing a Medicare Advantage Plan, check whether the built-in drug plan covers your prescription drugs.
#5: Heavy Advertising on Perks
You’ve probably seen a few television ads about “Medicare Plans.” Most of the time, these advertisements are about Medicare Advantage Plans, and they usually emphasize the plan’s perks.
These perks include gym memberships, Flex Cards, transportation benefits, and others, which can be really nice to have. However, it can burn you later if you choose a plan just because of the perks.
Remember, Medicare Advantage Plans are healthcare plans. So ensure a plan covers your healthcare needs first, before looking at the perks.
#4: Changes Every Year
Unlike Original Medicare, which only changes if legislation passes, Medicare Advantage Plans typically change their terms every year.
Your plan can increase its premium, change its copays and coinsurance, move prescription drugs into different tiers in its formulary, or add or drop doctors and hospitals in its network.
That’s why even if a Medicare Advantage Plan works great for you this year, be careful about blindly renewing your plan for next year without checking the changes.
Every year before September 30, your plan should send you an Annual Notice of Changes. This document goes over all your plan’s changes for the following year.
If you are unhappy for any reason, you can switch to a different Medicare Advantage Plan during the Annual Enrollment Period which runs from October 15 to December 7 every year.
#3: Switching to Medicare Supplement May be Difficult
You can generally join a Medicare Advantage Plan regardless of your health. However, the same is not always true for Medicare Supplement Plans.
When you first enroll in Medicare Part B, you get a six-month window to enroll in a Medicare Supplement Plan without undergoing medical underwriting. This period is known as the Medigap Open Enrollment Period.
You may be subject to medical underwriting if you want to join a Medicare Supplement Plan after your Medigap Open Enrollment Period has passed. During medical underwriting, you’ll be asked several health-related questions, and the insurance company can charge you higher premiums or deny your application if you don’t meet their criteria.
That’s why it’s important to compare your options before enrolling in Medicare. If you find you prefer a Medicare Supplement Plan, you won’t have to go through medical underwriting if you join during your Medigap Open Enrollment Period.
#2: Networks
Most Medicare Advantage Plans have networks of doctors and hospitals. Medicare Advantage Plans partner with several local doctors and hospitals to provide low-cost healthcare within their network.
Some plans, mostly HMO plans, typically don’t cover you outside their network except in emergencies. Other plans, like PPO plans, may charge you higher copays if you get services out-of-network.
People who live in areas with many doctors and hospitals around them typically don’t mind networks. However, if you live in a rural area, you may have a harder time finding a Medicare Advantage Plan with a good network for you.
#1: Referrals and Prior Authorizations
One of the main things that some people online attack is the referral and prior authorization process of Medicare Advantage Plans.
Because Medicare Advantage Plans are managed care plans, your insurance company typically has a say in your treatment. If you need to see a specialist, you may need to have your referral approved by the insurance company. If you need expensive treatment, you may need prior authorization from your insurance company before they cover your treatment.
While claims are occasionally declined, some people online tend to blow it out of proportion. These online “experts” make you believe that if you enroll in a Medicare Advantage Plan, it’ll be extremely difficult to get any type of expensive treatment you need.
In reality, a study suggested that 92.6% of prior authorization requests are approved up-front. The same study said people who are denied and appeal the decision also have an 83.2% success rate. Adding these together, you can see that it’s actually rare for a necessary treatment to be declined.
Another survey shows that 96% of Medicare Advantage enrollees are satisfied with their coverage.
That’s why, if you find someone online bashing Medicare Advantage Plans because of prior authorizations, consider the source and take what they’re saying with a grain of salt.
Chances are, they’re trying to sell you another type of plan because they’re not even licensed to sell Medicare Advantage Plans.
Alternatives to Medicare Advantage Plans
Many people who don’t enroll in a Medicare Advantage Plan choose to enroll in a Medicare Supplement Plan instead.
Medicare Supplement Plans generally have higher premiums than Medicare Advantage Plans, and they typically don’t provide additional coverage (many people with Medicare Supplement Plans enroll in a standalone Medicare Part D plan for prescription drug coverage).
However, some Medicare Supplement Plans have low copays and coinsurance. Medicare Supplement Plans also don’t have networks—if a healthcare provider accepts Original Medicare, they should take your Medicare Supplement Plan.
Below is a quick comparison chart between Medicare Supplement Plans and Medicare Advantage Plans.
| Medicare Supplement Plans | Medicare Advantage Plans | |
| How it Works | Secondary insurance to Original Medicare | “Alternative” to Original Medicare |
| Premiums | Typically higher than Medicare Advantage Plans | Low to $0 premiums |
| Cost Sharing | Usually lower compared to Medicare Advantage Plans | Generally higher than Medicare Supplement Plans |
| Additional Coverage | Covers the “gaps” in Original Medicare (does not typically cover prescription drugs, dental, hearing, or vision) | Usually has a built-in prescription drug plan and benefits for dental vision hearing care |
| Networks | Generally no networks—accepted by any doctor/hospital that takes Medicare | Typically has local networks, may cost more for out-of-network services or you may not be covered |
| Perks | Rarely has a few small perks like gym memberships | Often has many perks, like gym memberships, Flex Cards, transportation benefits, and more |
| Referrals and Prior Authorizations | Rarely requires referrals or prior authorizations | Typically requires referrals to see a specialist or prior authorizations for expensive treatment |
If you’d like to learn more about the differences between these two plans, or want to know the options available in your area, call or text us at +1 877-360-6565 (TTY: 711).
Conclusion: Medicare Advantage Plans are NOT “Bad” or “Good.”
The truth about Medicare Advantage Plans is that they work great for some people, while they might not be a fit for others.
That’s why it’s so important to understand how Medicare Advantage Plans work, its strong points, and its weaknesses.
When you’re well-informed about your options, you can avoid biased sales agents online, and make an informed decision regarding your Medicare. You’ll be able to enroll in the right Medicare plan fit for you!
Note: if you’re looking for unbiased help in finding the right plan for you, call or text our team of professional licensed insurance agents at +1 877-360-6565 (TTY: 711):
Calvin Bagley is the founder of PlanFit, The Medicare Store, and Nuvo Health. He and his team have helped over 60,000 people navigate Medicare options, and he’s a nationally recognized speaker in the Medicare industry. Most importantly, he’s someone who believes every American deserves clear, honest information without pressure.
