• Brad Gunning

Medicare Advantage Pros and Cons


We are currently in the Annual Election Period (through December 7). Now is the time when beneficiaries can enroll in, switch, or cancel their Medicare Advantage plan.


Medicare Advantage plans are an alternative to Original Medicare. You receive your benefits from a private insurance company, rather than the government. That said, you'll still need to continue to pay your Part B premium.


Medicare Advantage Cons

One of the main cons with Medicare Advantage is you're giving up some freedom. With Original Medicare, you can go to any doctor that accepts Medicare (almost all of them). With Medicare Advantage, you'll be in a network (usually an HMO or PPO). If you want to see a specialist, you'll likely need a referral.


It's also worth noting that you cannot be enrolled in both a Medicare Advantage plan and a Medicare Supplement plan (Medigap) at the same time. Medigap plans are federally standardized, so you know exactly what you're getting with each plan. Medicare Advantage plans, however, can vary county-to-county, so it's important to read through the plan's Summary of Benefits. Figuring out exactly what your Medicare Advantage plan covers can be confusing and it's not helped by the deluge of misleading advertising on TV.


Medicare Advantage Pros

Some of the pros of Medicare Advantage are that they usually combine benefits beyond what's offered by Original Medicare. For example, prescription drug coverage, dental and vision coverage, discounts on gym memberships, transportation, and home care.


Cost savings is another pro of Medicare Advantage plans when compared to Medigap. Monthly premiums for Medigap plans tend to be in the hundreds of dollars, while most counties have Medicare Advantage plans with low, often $0, monthly premiums. In fact, while it's important to keep in mind you'll still have your Part B premium, some Medicare Advantage plans refund a portion of your Part B premium.


Medicare.gov is a good starting point for review 2023 plan options, although it might be easier to contact an independent agent and have them run a comparison report for you. Ultimately, these new benefits are a great addition to a Medicare Advantage plan, however, one potential con is focusing on the fringe benefits over the core health benefits. At the top of the Medicare Advantage comparison checklist should be the max out-of-pocket, the network, how well the plan handles your prescriptions, and the various co-pays and deductibles.

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