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5 Common Misconceptions About Medicare Advantage: Debunking the Myths

Do you know the facts about Medicare Advantage plans? Learn the most common myths versus the facts so you can make informed decisions about your healthcare.
medicare advantage facts

Medicare Advantage plans have become increasingly popular among seniors seeking comprehensive healthcare coverage. Despite the grow in popularity, we continue to see a lot of Medicare Advantage misconceptions circling the internet. We want to help beneficiaries make more informed decisions and breakdown some common myths about Medicare Advantage.

How many beneficiaries choose Medicare Advantage?

More than half (51%) of the Medicare eligible population are enrolled in a Medicare Advantage plan as of 2023. This number is even higher in counties with a larger amount of Medicare Advantages plans, with as many as 60% of Medicare eligibles enrolled in them.

Where does the misconception come from?

We don’t know if this comes from some agents who only sell Medicare Supplements and do not take the time to explain all options for beneficiaries. Or, if it is because some beneficiaries have been on a medigap plan for many years and aren’t familiar with how Medicare Advantage plans work. In this blog post, we’ll cover some of the most common myths about Medicare Advantage so you can make informed decisions for yourself.

What are some common myths and misconceptions about Medicare Advantage Plans?

Medicare Advantage Myth #1: Medicare Advantage Plans Are More Expensive Than Original Medicare and Medicare Supplements.

In reality, Medicare Advantage plans can often be more cost-effective than these other coverage options. Medicare Advantage plans are required to cover AT LEAST what Original Medicare covers. But they typically have a lower cost share and include an out-of-pocket maximum to keep costs down. This provides some financial protection against many unexpected catastrophic medical expenses. Original Medicare does not have a maximum out-of-pocket cost so there is no limit on how high your medical bills can be in any given year.

Compared to Medicare Supplements, Medicare Advantage plans have lower or $0 premium plans. Saving on monthly premiums may make more financial sense for some people. Medicare Supplement premiums can continue to increase year after year, making them even more costly over time.

Myth #2: Medicare Advantage Plans Limit Your Freedom when seeking care.

Medicare Advantage plans are similar to the group and employer plans that most people have been accustomed to when seeking care. Medicare Advantage plans offer both HMO and PPO plans. HMO plans do have a preferred network of providers you need to use, but PPO plans allow you to go out-of-network if you choose. So, you can choose whichever network type you prefer depending on your desired level of flexibility. Before enrolling in any plan, a licensed agent can help search all plans to see which ones already have your doctors in network.  Hospitals are never restricted when seeking emergency care in either plan type. If you do choose a Medicare Advantage HMO plan, many plans still allow you to see a specialist without getting a referral from your primary care provider. PPO plans will always let you got to a specialists without a referral.

Myth #3: Medicare Advantage Plans Are Complicated and Difficult to Navigate

While Medicare Advantage plans may seem complex at first glance, they consolidate your healthcare coverage into a single plan to better manage care. This can be easier to manage compared to Original Medicare, which requires a separate Part D plan for prescription drug coverage and possibly a third plan for a Medicare Supplement. Unlike Medicare Advantage, this means three different cards when you go to the doctor or pharmacy. It also means three different entities paying different portions of your healthcare costs. This can become more complicated and frustrating when billing errors occur than if you were on a combined Medicare Advantage plan. For instance, if you have a billing error for a doctor’s visit, you may have to call both Medicare and your Medicare Supplement company to straighten it out and make sure your bills get paid.

Myth #4: You Can’t Switch Medicare Advantage Plans Once You’ve Enrolled

Another common misconception is that once you’ve enrolled in a Medicare Advantage plan, you’re stuck with it for the rest of the year. In reality, Medicare has some safeguards for people in certain circumstances to make changes to their Medicare Advantage plans. One such enrollment period is the Medicare Advantage Open Enrollment Period. This enrollment period is in the beginning of each year, after the Annual Election Period has ended. This allows people the opportunity to use and reassess their Medicare Advantage plan for the year. If their plan is not what they need, then they can make a change during this time. Read more about other Special Enrollment Periods in our previous blog, Your Complete Guide to Medicare Enrollment Periods.

Medicare Advantage Enrollment Periods.

Myth #5: Medicare Advantage Plans Offer Inferior Coverage Compared to Original Medicare

As mentioned, Medicare Advantage plans are required to provide at least the same level of coverage as Original Medicare. Most Medicare Advantage plans also include additional benefits that Original Medicare and Medicare supplements do not.  These can include prescription drug coverage, dental, vision, over-the-counter spending, fitness memberships, and hearing aid benefits. Furthermore, Medicare Advantage plans often provide coordinated care management and preventive services to help members stay healthy and manage chronic conditions.

Don’t let misconceptions about Medicare Advantage plans prevent you from comparing this valuable healthcare option to other Medicare plans. Most people already have experience with group and employer plans, so Medicare Advantage may be more familiar territory for them to navigate. There is not one right answer for everyone. You can find your perfect fit by comparing Medicare Advantage Plans to Medicare Supplements Here.

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