Pros & Cons of Medicare Advantage: Benefits Outweigh the Cons

If you’re eligible for Medicare, or going to be soon, and you’re currently seeking to choose a Medicare plan, then you might be a little overwhelmed! There’s a lot of information to compare, contrast, and consider. It can be intimidating to try to delve into the differences between Original Medicare and Medicare Advantage plans and find one that works for you. The pros and cons are plentiful!

The good news is, we’re here to help.

Pros & Cons of Choosing Original Medicare

With Original Medicare, there are a few clear benefits that are worth mentioning.

One of these is that you don’t have to "choose" a plan. With Original Medicare, as long as you’re already receiving Social Security benefits, you’ll automatically receive Medicare Parts A and B as soon as you become eligible.

If you’re not currently receiving benefits from Social Security, you simply have to sign up for Medicare Part A and B. You can sign up online, or through your local Social Security office. They’ll review your records and determine your eligibility.

Other benefits of Original Medicare include:

1. You can choose any doctor that accepts Medicare assignment

That’s right. You can choose any doctor you like – as long as they accept Medicare assignment. But, this is a great benefit because many Medicare Advantage plans require that you choose a doctor on the plan’s network, which might not coincide with your preferences.

2. Services are covered no matter where you are in the U.S.

Unlike Medicare Advantage plans, you can receive full Medicare coverage no matter where you are in the U.S. This means you’re safe to travel and/or live wherever you’d like.

3. Access to Specialists

This can be a big perk for those who regularly require or prefer to visit a specialist. Original Medicare does not require a referral from a primary care doctor in order to see a specialist.

The cons of choosing Original Medicare are typically enough to outweigh the pros. 

Original Medicare is oftentimes more expensive and offers fewer benefits than Medicare Advantage plans.

Additionally, Original Medicare does not include prescription medication (Medicare Part D), and it doesn’t cover long-term care, dental care, eye glasses prescriptions, hearing aids, and other non-essential but beneficial medical needs.

Pros & Cons of Medicare Advantage

Medicare Advantage plans communicate benefit in the name itself. There IS generally an advantage to choosing one of these plans!

One major advantage is that you have a plethora of plan options to choose from – each with different benefits from the last. With Medicare Advantage, you’re more likely to find a plan that’s specific to your needs.

Other benefits of Medicare Advantage plans include:

1. More Medical Coverage

One of the most significant benefits of a Medicare Advantage Plan is the coverage. With these plans, you typically gain more coverage for less money.

While all Medicare Advantage Plans, like Original Medicare, include Medicare Parts A and B, they can also include benefits that Original Medicare specifically does not cover – like Dental, Vision, and even health and wellness programs.

2. Can Be Less Expensive

Surprisingly, Medicare Advantage plans oftentimes are less expensive than Medicare itself (especially considering the additional coverage they offer).

Premiums for Medicare Part A can be as low as $0. Plus, many plans include an "Out of Pocket Maximum" which means that your plan will begin covering your medical needs in FULL once you’ve reached this limit.

3. Part D Prescription Drug Coverage Built-In

Most, if not all, Medicare Advantage plans include some type of prescription drug coverage. This is one of the biggest benefits to choosing a Medicare Advantage plan over Original Medicare.

Prescription drugs are something that we all need at some point or another and having an insurance plan that covers this need is key!

The cons of choosing a Medicare Advantage plan are not enough to outweigh the pros.

As stated before, there are a lot of options when it comes to Medicare Advantage plans. This can be a negative, as it takes time to sift through options and find what’s best for you.

Additionally, three of the main benefits to choosing Original Medicare are three of the main cons to choosing Medicare Advantage!

Medicare Advantage plans are often regional. In order to receive coverage, you must reside in the area that your Medicare Advantage plan services for at least six months out of the year. They also tend to require referrals from your primary care physician to receive specialist coverage and you may even have less physicians to choose from. These plans often have a list of providers in their network that you can choose from, rather than the freedom of choosing any health care provider who accepts Medicare.

Choosing the Right Plan for You

There's so much to consider when it comes to choosing a Medicare plan - especially one that’s right for you. 

Because of this, it's often helpful to find a local advisor/agent who can help you choose between Original Medicare and a Medicare Advantage plan. They can explain exactly what you qualify for, what plans you have to choose from, when you can enroll, and what you can expect going forward. 

Plus, these agents will cost you nothing! Agents are paid by carriers, are unbiased towards any one plan, and are really there to help you determine the best plan for you, personally, based on your needs and priorities. They can even provide ongoing advice, no matter what you might encounter with your plan. 

So, what are you waiting for? Reach out to a Plan Advisor near you to get started! 

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