Medicare Advantage Plans Pros and Downsides

Medicare Advantage plans, is referred to as Part C Medicare.  This is one of the beneficiaries received as the benefits of Medicare covered under Part A and B Original Medicare. There is an exception only with hospice care, while it may include benefits such as coverage for vision, dental and prescription drug.


How do these plans function?

Medicare Advantage plans are issued by Medicare approved private insurance companies. Every month, the working system is that the Medicare pays a fixed amount to the private insurance company and that private company covers your costs based on the Medicare set rules.


Medicare Advantage plans are available in different types, and the benefits vary with each plan. In fact, majority of the plans are inclusive of the coverage for drug prescribed in a type of plan referred to as Medicare Advantage featuring the drug prescribed plan. There are Medicare Advantage plans different forms such as:


  • Health- Maintenance- Organization- (HMO)
  • HMO- Point-Of-Service- (HMOPOS)
  • Preferred-Provider- Organization- (PPO)
  • Medical-Savings- Account- (MSA)
  • Private- Fee-for-Service-(PFFS)
  • Special-Needs- Plans- (SNPs)

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What is Medicare Advantage plans downsides?

The coverage with Medicare Advantage plans is functional through private insurance companies and there is difference in their guidelines and rules leading to restrictions:


  • Medicare Advantage plans of each type are based on the insurance company and thus they need higher costs as out of pocket than Traditional Medicare. In fact, each year, the plan benefits, premiums and copayments change.
  • The insurance company expects to adhere to the strict rules to avail coverage for some health products and services, such as to see specialists there is a need for referral. You may change hospital or doctor within the plans network and receive coverage as per the plan or else you must be ready to pay more cost.
  • There are annual contracts in Medicare Advantage plans and so one can choose to avoid renewing the contract.


Medicare Advantage plans pros

  • Insurance companies provide a premium of $0 for Medicare Advantage plan and the availability is based on the state and county you live.
  • The Advantage plans offer more than Original Medicare as it offer additional cover as benefits such as dental or vision coverage.
  • Each plan features a maximum limit for out-of pocket expenses each year on health costs. On reaching the limit, you need to pay nothing for the services covered.