3 Reasons to Reject a 5 Star Medicare Advantage Plan ⭐⭐⭐⭐⭐

3 Reasons to Reject a 5 Star Medicare Advantage Plan ⭐⭐⭐⭐⭐- Call us at iHealthBrokers today at 888-410-0344. Our services are 100% Free!

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0:00 Intro
0:50 What is Medicare Advantage?
1:59 Preauthorization & Referrals
3:45 OOP Expenses
6:05 Networks & Travel
7:11 Final Thoughts

So what are medicare advantage plans? MA plans are sometimes referred to as Part C plans or Managed Care Plans. They are an alternative to Original Medicare. So, they will replace your original Medicare entirely. They must offer at least the same benefits as Part A & Part B but very often they will offer additional benefits such as dental, vision, hearing, prescription drugs and more. You’ll also have an OOP which is not offered by Original Medicare. These plans are offered by private carriers. Benefits and prices can vary widely. Some plans will even claim to be “free”. Of course, they are not. You will have pay for Part B at the very least. Basically, Original Medicare will pay a Medicare Advantage plan for taking on the risk of a beneficiary, but you will still have to contribute financially. All of this may sound pretty good, but now let’s dive into three reasons you may want to reject a Medicare Advantage Plan.

Preauthorization and Referrals
Medicare Advantage plans are offered by private carriers. The plans are not standardized and can offer different benefits. The need for preauthorization and referrals can be a major problem.
You are probably familiar with referrals. Basically, if you need to see a specialist, you have to go through your PCP. Not only is this an additional appointment, but it’s additional wait time. Days and weeks can stack quickly and can be extremely detrimental to your health when time is of the essence.
Peauthorization is another major hurdle. Additionallyven if your doctor authorizes certain tests or procedures, your insurance may have to preauthorize these services. This can lead to longer waiting times or possible denials. This is not the case with Medigap plans.

Out of Pocket Expenses
As I mentioned earlier, many Medicare Advantage plans claim to be free. But in the fine print, you’ll see that at least you have continue to pay for Part B. When you compare these costs and the added benefit to a Medigap plan, it’s easy to see why many people are enticed. However these plans may cost you in the long run.
Another problem is the out of pocket maximum. Now, of course, this a very good thing and it’s designed to help protect you from major medical bills.
However, this OOP max resets every year. So, if you are undergoing continuous or long term medical care, you will need to meet that OOP max again once the year resets. This can be quite a financial burden when compared with medigap plans.
With a medigap plan, you pay a larger monthly premium and than almost all of your medical bills for the year will be covered. So, with Plan G, for example, your financial spending is limited to your monthly premiums and your Part B deductible. All other expenses are covered regardless of how much medical you may need.
You also have to take into consideration potential oop expenses for doctors and hospitals that are not within network.

Networks & Travel
That brings us to the last reason you may want to reject a MA plan: networks. With MA plans, you need to utilize hospitals and doctors that are in network. This can be very restricting. People have even reported having to travel significant distances to find specialists who accepted their plans. With larger medical needs as we age, this can be a major problem.
Additionally, you may not have coverage if you choose to travel. Travel is one of the thing that so many people look forward to in this retirement and lack of adequate coverage could certainly put a damper on that.
If you are interested in a Medicare Advantage Plan, you can enroll during the AEP (Annual Enrollment Period) which is every year from October 15th to December 7th.

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[rbyham]

Nice try honey but I have had both and would never go back from my current advantage plan... so much cheaper... have saved thousands this year. Drove me crazy paying premiums on months I had no need of medical care...

[g]

Most PPO Advantage plans DO NOT require a referral from a PCP to see a specialist. But an HMO, yes.

[juliaashley]

my union just started adding medicare advantage through aetna. they give you $75 credit toward medicare premium. BUT you have to find a provider
who accepts the medicare advantage plan. i ain't going for it. be careful. too good to be true? you got it.