Florida Medicare Advantage Pros and Cons

Medicare Advantage PlansFlorida Medicare Advantage plans are sometimes referred to as Medicare Part C plans. Here is how they work.

Medicare is made up of different parts.

Part A is the hospital part and resembles something we used to call hospitalization. Simply speaking it covers your hospital bills. Its free from the government.

Part B is the outpatient part of Medicare. It covers doctor bills, labs, testing and the things you would normally associate as the outpatient costs. It is not free and costs about $135 a month depending on your income.

Part D is the pharmacy part of Medicare. You buy a plan based on what prescriptions you take. Some plans will cover more prescriptions or let you buy certain medications for less money than others. Again, you pay for this plan as it has nothing to do with the government.

If you read any other part of this website you would also know that you can buy a Medicare Supplement to cover the expenses that Part A and B do not cover.

Simple so far.

The Medicare Supplements have a monthly premium as does the Part D prescription plan. Depending on which plan you take it can be a few hundred dollars a month or more.

Insurance companies saw an opportunity in all of this. They created their own plans that would take care of everything and either charge a very low fee or in many cases nothing at all.

It does not make sense when you first hear this does it? After all, if you have lived longer enough to be eligible for Medicare you full well know there is no such thing as a free lunch. Somebody has to pay the insurance companies.

Somebody does and that somebody is the government.

The insurance companies make a deal with Medicare or CMS (the agency that administers Medicare) to get paid a monthly premium. For the premium that the government pays them they will take over your Medicare benefits. They will become the payer of all your eligible medical bills.

Wow, sounds too good to be true. There has to be a catch to all of this. Of course there is.

Before I tell you why I do not like Medicare Advantage plans let me say that for many people these plans work out very well. Plus, a number of seniors cannot afford the costs of supplements. Medicare Advantage plans help them to obtain medical care without going broke.

Medicare Advantage PlanĀ  Disadvantages

There is a network of doctors and hospitals. It is much smaller than the number of physicians and hospitals that accept regular Medicare.

You usually have a copay or fee for visits to a specialist.

While most of these plans offer a prescription benefit, it might not cover your medications or the cost for your medications might be very high. In other words it is a very low-end Rx plan.

You still must pay for your Part B Medicare to be eligible for one of these plans.

This one is very important. Once you have had the plan for more than a year you might not be able to ever switch back and buy a regular Medicare Supplement. To me that is scary. If my physician decides they no longer want to accept the plan, I will have to find a new one. Depending on what part of the country I live in I might have to drive insane distances to find specialists who will accept the plan. If I get very sick and want to doctors or hospitals not in the network it can become a major expense. While most plans have some provision for out of network coverage, it is at a much higher cost.

The Bottom Line

If the prescription plan covers your medications adequately and if you are able to find a physician you like in the Medicare Advantage network it can work out very well. But, and this is only my opinion, if you can afford to purchase a regular Medicare supplement I strongly suggest you do so. I have never heard anyone say “I should have purchased a Medicare Advantage plan because the coverage is so much better.” But I have most certainly heard the opposite.

If you are looking at a Medicare Advantage plan and need an outside pair of eyes to look at it for you give us a call. If you want to find out how much it costs to have the real Medicare plan instead, we can help with that too. You might be surprised how affordable it is.