Medicare Advantage Plans
Why we will not sell these plans.
Required to opt out of Medicare’s regular benefits.
Must pay the Part B premiums for Medicare. (In 2019, $135.50 per month or higher.)
+ Premium can be lower than Traditional Medicare + MediGap + Prescription Card
+ Advantage plans may include dental-vision-prescription benefits.
– Plans and their benefits are not standardized – each contract is unique.
– Plan may only be available in limited counties within a state.
– Must live within service area within the state – ask about service outside your area.
– Most are of HMO design – no coverage outside the list of providers. (A few plans are PPO)
– Limitations felt with serious illness.
– High out-of-pocket at claim time can be $5,000+.
– Copays for many services.
– Limited services – they decide, not you.
– Prescriptions provided determined by plan.
– Pre-certification for some services.
– Primary doctor’s “ok” needed for specialist review.
– Service out-of-state could be difficult.
– Not portable if one moves out of state.
– Enrollment/Plan Change/Dis-enrollment Limitations.
Every Fall/Winter you’re given an opportunity to return to original Medicare. Additionally, you may return to original Medicare anytime during the first 12 months of your first Advantage plan.
I see few clients move to Advantage from original Medicare, while the reverse happens frequently!