Medicare Advantage, The Pros, and Cons “Medicare Advantage: The Good, the Bad, and the Ugly – Prepare to Be Shocked!
These popular Medicare Advantage plans may carry hidden risks. Here’s what to know.
By Penelope Wang
Consumer Reports | Published October 14, 2021, | Updated November 15, 2021, | Medicare Advantage
If you’re one of the 63 million Americans enrolled in Medicare, you’re probably being deluged by marketing pitches for Medicare Advantage plans, which offer managed care with low or zero premiums.
Medicare’s fall open enrollment season starts Oct. 15 and runs through Dec. 7, when you can switch your coverage between Original Medicare and Medicare Advantage, change Medicare Advantage plans, or make changes to your prescription drug plan.
All that marketing seems to be working. Recently, 42 percent of Medicare beneficiaries were enrolled in Advantage plans, up from 31 percent in 2016, according to data from the Kaiser Family Foundation. Those numbers include 50 percent of Black and 54 percent of Hispanic enrollees vs. 36 percent of whites in 2018. By 2025, half of Americans are expected to be in Advantage plans.
It’s easy to see the appeal of Advantage. Original Medicare doesn’t cover all your medical expenses, while Advantage plans have cost-sharing requirements but then cap your out-of-pocket costs. Plus, you have low premiums and the simplicity of all-in-one coverage.
But there can be hidden risks to Advantage plans, especially for those with major health issues.
“Some people in Medicare Advantage end up paying unexpectedly high costs when they become ill or find their network lacks the providers they need,” says Tricia Neuman, senior vice president at Kaiser.
Your alternative is to opt for Original Medicare and add a supplemental, or Medigap, a plan that covers your out-of-pocket costs and gives you a wider choice of providers. But you’ll pay additional monthly premiums for a Medigap policy, and unless you’re enrolling in Medicare for the first time, you could be denied Medigap coverage due to a preexisting condition.
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