Cons Of The Medicare Advantage Plan

Medicare Advantage (MA) plans, also known as Medicare Part C, were instituted by the federal government in 2003 to offer consumers an alternative to the traditional Medicare Parts A and B. They were intended to provide seniors with more health care choices by giving them the option to obtain coverage from private insurers. While the freedom of choice is attractive to some, there are also disadvantages with MA plans.

Network Restrictions

Since most MA plans require enrollees to join a network such as a Preferred Provider Organization (PPO) or a Health Maintenance Organization (HMO), it means they must see doctors who are also members of the network. For seniors who have a longstanding relationship with their primary care physician, they may need to go through what could be an undesirable process of having to change doctors.

Plan Changes

It is possible that if an MA provider is unprofitable in a certain geographic area, it could discontinue coverage, which could leave seniors scrambling to find replacement care. Premiums, deductibles, and copayments could also change at the end of the year. A change in benefits could mean that coverage for a specified illness or condition may be eliminated. If an insured person is dissatisfied with the MA plan and wishes to switch back to the original Medicare, it may not be possible to pick up a Medicare Supplement policy since health requirements may need to be met.

Additional Expenses

For insured people who decide to seek care outside of their MA plan's network, they will likely need to pay part or all of the costs out of their own pockets. This can be especially problematic when the need arises to find a specialist. Even when staying within the network, additional expenses could be incurred if there is a need to use health care services frequently.

Limited Coverage Area

Some MA plans could be limited as to where they will they will extend coverage. This could provide difficulties for seniors who like to travel. For example, a senior who is vacationing in Florida and suffers an injury may discover that his MA plan does not provide coverage in that state.

Confusion

Some areas provide access to 50 or more MA plans, most of which are rather complex, so deciding which one to purchase can cause a great deal of confusion. In some cases, the senior will need to completely rely on the advice and trustworthiness of the sales agent to make the decision. This differs from traditional Medicare where there is one plan available for everybody.

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