Why Medicare Advantage Plans are Bad (or Are They?)

Everyone has their opinions about Medicare Advantage plans! Chances are that you may have come across a provider who tells you Medicare Advantage plans are bad. Or perhaps you have had a few friends tell you the reasons why they would never enroll in a Medicare Advantage plan. Here is Why Medicare Advantage Plans are Bad (or Are They?)

Start (00:00)
Reality of Medicare Advantage plans (0:38)
Medicare Advantage vs Medigap out-of-pocket (1:24)
Review Summary of Benefits (2:47)
How Medicare Advantage plans are paid (3:44)
You still pay Part B premium (4:15)
Medicare Advantage plan networks (4:51)
Annual changes (7:12)
Out-of-pocket maximum limit (9:06)
Prior authorization (10:36)

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[MalikaBourne]

thank you for explaining this so well. I had an advantage plan for years. Overall I liked it. However, I was paying $10, 000 a year out of my pocket for things not covered and copays. I switched to a local senior supplement plan (monthly fee) and straight Medicare- Oh my - so much less paperwork in the mail and no co-pays. That plan covers the hospital system providers that I prefer.
The advantage plan works well for my disabled adult son who also has Medicaid.

[SteveLionel]

I love BoomerBenefits, but I found this video to be heavily slanted toward Medigap plans. Danielle never mentioned the medical (not talking hearing/vision/dental) services covered by an Advantage plan that Medicare doesn't cover. Also, many Advantage plans have zero for commonly used services including prescription drugs (she never mentioned that many Advantage plans include drug coverage, which a Medigap user would have to buy separately. Also not mentioned is what a PPO plan does - it lets you go outside your network (sometimes for a higher copay) if you want.

[Tigerroux]

Research your medicare book you receive each year and compare the plans in the back of book. Check out of pocket expenses. Call the plans directly if questions. They list phone numbers. You don’t need a third party as they can be confusing to you. Advantage plans are great for lower cost. The only disadvantage is the network part. You need to check your clinics and doctors acceptance of what plans they use. No referrals are used as in the past - at least in FL. Never had a hassle with this with my advantage plan. If you travel a lot, then a regular medicare coverage may be best.

[markaustin]

It seems the only upside with Medicare Advantage is lower premiums than Medigap plans. But the downside of MA is far worse than the downside of Medigap coverage. MA is good for relatively healthy people who are able to stay "in network"

[WorldWideCynthia]

My mother's retired from a school district. They recently enrolled her in this MAP - she didn't have a choice. At 85 she was forced into it so that's what sucks the most. She lost her Primary Care Dr. and other items she was used to.

[bilahn]

I work for a very large employer and the Advantage plan I'm considering really does not have a lot of these problems. The $168 premium is well worth it. It is basically very similar to the group coverage I have now. I was told that my advantage plan should be considered "deluxe"

I get the impression though that most Advantage plans are not this good. I feel pretty fortunate and wish everyone had this kind of access.

[billyrayband]

Explained very well. But I always have some distrust of both government programs and insurance companies. How much does medicare pay each month to the insurance company to take over coverage in an advantage plan?

[techguy]

Seems that Advantage Plans aren’t for me.

[bilahn]

Depends on the plan! Mine is rather high priced and is very comprehensive

[CHixon]

The last company HMO plan I was on was terrible. The Dr
network consisted of physicians from the bottom of the barrel. My last primary care dr was an infectious disease specialist (imagine sitting in his crowded waiting room) who was finally barred from practicing medicine by the ama. He was the best on the list IMO. That was 20 years ago and since then, I have considered it better to not carry insurance, pay cash instead.

[kygent]

They are good depending on where you live.

[tonyreddy]

I investigated medigap plans. Premiums were 350-500 per month, in other words $4, 000-$5, 00 annual premium for a private insurer plan. I can get an Advantage plan with $5, 000 cap (this insurance pays everything above $5, 00) for $1500 annual premium. The premium for medigap may be higher in New York b/c they consider EVERYONE eligible regardless of price-existing condition and regardless of age. (When I turned 65 I was only eligible for medigap for 6 months one time opportunity but declined). Apparently allstates must offer initial enrollment for the aforementioned 6 months. After that insurance companies have the option to reject based on pre-existing condition so check your state to see how they handle this.

[jimbattles]

I have a Medicare Advantage plan that is specific to a large company that I retired. it is a specific plan with different deductibles and prescription payments. I have been happy with the plan and have not had any problems. it is a ppo plan and does not have in network and out of network differences.

[julieoliver]

Ok, I'm in GA & looking at Medigap insurance, I thought that was suppose to cover deductibles & co-pays, but the ones that are in my area, the Medigap itself has a deductible before it will pick up & that's with a costly premium. I was really thinking about doing Medicare w/ Medigap, but that would be a dumb idea, especially when it doesn't help with medicine or dental. I guess it's too each its own & what your individual needs are. But I have read so much information & watched videos until I'm blue in the face. So the government has screwed us once again!

[Maggie-trkd]

I think your presentation on Medicare Advantage plans was well-balanced and not slanted necessarily to MA plans or Medigap plans. Knowledge and understanding of how the various plans work is critical before selecting the one that is right for you. I only regret that MA plans are so heavily promoted by some companies without disclosures of the limitations. That is why it may be well worth consulting with an expert such as you before choosing a plan. If you know the restrictions and limitations of a MA plan and potential costs on the back-end and that is acceptable to you, then a MA plan may be right for you. For myself, I chose a Medigap plan and I have never regretted my decision.

[robinmccall]

Can you go from an Advantage plan to a medigap plan

[sueschweickert]

I tried to get a medigap plan and was denied. My only option is an advantage plan.

[captainkangaroo]

I believe that if your still working after age 65 and have a high deductible health plan and are contributing to an HSA those pretax funds can be used to pay the premiums but for some reason those funds can not be used for medigap premiums.

[bradleyfoster]

I really love the content you posted, it is always super helpful and informative. Keep posting such an amazing videos, I love watching all your videos.

[charlesmichael]

A complex confusing subject and I am just starting out in it at 65 this year. I was with Kaiser for many years and was pleased with their service. Comparing Kaiser HMO medicare advantage premiums to regular medicare, Kaiser premiums are only about $60-$70/mo cheaper than a middle cost medigap policy and a part D policy combined. Difference is, medigap has minimal out of pocket costs while kaiser has $3400 our of pocket as of 2021. BUT, part D drug plans that go along with medigap plans are such cheezy sketchy policies that one can be out of pocket by at least $6500 and maybe more depending on what kind of costly meds you may come to need. Part D is real crap! They can constantly changing what and how much they cover for any drug - rotating out of full coverage for whatever drug is costing them a lot in any given year. So, you get no predictable coverage which is the whole point of insurance to hedge you against extreme catastrophic expenses. Same with the advantage plans which can change coverage of all kinds and raise out of pocket as high as the $7K limit whenever they want.
One feature she did not mention is that, if you are in an advantage plan and get a major expensive long term illness, you may not be able to switch back to the low out of pocket medigap coverage. Medigap insurers can exclude you from coverage due to certain pre existing conditions. So, if you are generally healthy, an advantage plan can save you a bit of money on premiums but if you gat a major illness, which is inevitable in old age, you could face larger out of pocket costs up to the allowed $7K+ maximum. If your illness is long term and expensive then you may face that out of pocket forever if you cannot return to regular medicare with its slightly more costly premiums but far less exposure to major out of pocket costs - except via crappy Part D coverage. Go figure! Pick your poison. Medicare is a pathetic excuse for a single payer system which works well all over the world and costs 30-40% less than our system and everybody get blanket coverage for everything. Fed up only 2 months into medicare