Medicare Advantage Plan PaperworkChances are if you are over 65 and on Medicare, you have seen ads on TV or been contacted directly by an insurance agent about enrolling in a Medicare Advantage Plan. The sales pitch might sound too good to be true, and depending on your specific circumstance, it might not be the best option for you. We take a look at the advantages and disadvantages of these plans to help you make the right choice for your healthcare.

What Is a Medicare Advantage Plan?

Medicare Advantage Plans are offered by private insurance companies that have been approved by Medicare to offer Medicare Part A and Part B coverage. When you enroll in one, you will no longer be covered by traditional Medicare, but your plan should provide the same coverage—if not more. Many Medicare Advantage Plans include drug coverage (Part D), and some include dental, hearing, and vision care. The insurance companies offering these plans must follow rules set by Medicare, but they can set their own premiums and co-pays. They can also limit which doctors and hospitals you can go to.

Pros and Cons of Medicare Advantage Plans

Insurance companies that offer these plans will sell them as covering more of your healthcare costs for less money. But you don’t get to be 65 years old without learning that if something sounds too good to be true, it probably is. As with everything, there are advantages and disadvantages to these plans. The pros depend on the specific plan, but in general, they provide coverage or cost savings for services that Medicare doesn’t cover, and they might offer lower or no monthly premiums. Some disadvantages might include:

  • Not every doctor accepts every plan. Most Medicare Advantage Plans operate like an HMO, with a list of medical providers you have to choose from. If you have already established a relationship with a particular primary care doctor or specialist, you will want to make sure they accept your plan. The same is true for hospitals—you might not be able to go to the hospital of your choice and be covered.
  • Limits on geographic service area. Because Medicare is a federal plan, you can go anywhere in the U.S. and be covered. Medicare Advantage plans, however, are local or regional plans, so if you spend winters in another state, for example, you might not have non-emergency medical coverage there.
  • High out-of-pocket cap. In 2022, Medicare caps the amount you can be expected to pay out of pocket with an Advantage plan at $7,550. That might be prohibitive for some subscribers.

Before you take the bait and sign up for a Medicare Advantage Plan, it’s important that you compare plans and ask questions about which doctors accept the plan, how much the premiums are, whether prescription medications are covered and whether they cover dental, vision, and hearing services. You don’t want to find out after the fact that your doctor, who was fully covered by Medicare, doesn’t accept your Advantage Plan at all.

Remember: No Kind of Medicare Pays for Nursing Homes

Regardless of whether you stick to traditional Medicare and add Medigap coverage or opt for a Medicare Advantage Plan, the cost of a nursing home is not going to be covered by either plan. While both plans will cover a short-term stay of up to 100 days, they do not cover long-term or permanent residence in a nursing home. To pay for that, you will need long-term care insurance or personal assets. You can also talk to a Medicaid planning attorney about qualifying for government assistance

Are You Looking for an Elder Law Attorney in Texarkana, TX?

If you need help with accessing senior benefits in Texas or Arkansas, you need to speak with experienced Elder Law attorneys as soon as possible. Contact us online or call our Texarkana office directly at 903.223.5653. We also have offices in Tyler, Paris, and Longview, as well as Magnolia, AR!


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Kline Pillow helps clients in TX and AR planning for the aging process with a specialty in Guardianship cases.