How Medicare Advantage Plans Work And Its Pitfalls

Kreg Bale
Kreg Bale December 24, 2019
Updated 2022/08/22 at 3:56 PM
Medicare Advantage Plans

This post will explore how Medicare Advantage plans work and  its pitfalls. Medicare Advantage plans are widely used in private insurance option for Medicare. But there are some advantages and pitfalls you should know about. For instance, some advantages include long-term savings, plan flexibility, and enhanced care. But some plans may lead to fewer options and extra costs and limitations when you are out of coverage areas. The pitfalls include many plans to choose from leading to confusion and so on. In this post, I will show you the advantages and pitfalls and what you must consider before you choose the service for you and your family. Let us start now.

How Medicare Advantage Plans Work And Its Pitfalls

What is Medicare Advantage

Medicare advantage is also called “medicare part C” and you get this insurance through private insurance providers. The coverage has medical and hospital insurance and additional perks. For instance, if you enroll for Medicare parts A and B, you will be eligible for the Medicare Advantage plan.

Most of Medicare advantage coverage has the following features. They include; Hospital coverage, Medical coverage, prescription and drug coverage, Dental, vision, and hearing coverage, and additional health perks.

Different types of Medicare Insurance and how they work

Also, you have different types of Medicare Advantage plans to pick from. They include:

  • Health maintenance organization (HMO.) Where you have a network of doctors that need a referral from specialists.
  • Peferred Provider Organization (PPO.) Who charges a different rate depending on if the service is in or out of network services.
  • Private Fee for Service (PFFS.)This plan has a unique payment option that gives you flexibility from the service provider.
  • Special Needs Plans (SNP.)This service offers long term medical payments for chronic conditions.
  • Medical Savings Account (MSA.)This plan is matched with high deductible health plans

The advantages of Medicare Advantage plans

When you compare Medicare Advantage to original Medicare, you will see the following advantages.

Convenient coverage options: The Original medical coverage covers just two services; like hospital and medical coverage. And those that need more coverage must buy Medical part D to cover prescription drug and Medigap for extra coverage. But if you have a Medical Advantage plan, all your coverage choices are in one handy plan.

Personalized plan structures: Medical Advantage plans provide different types of options for your specific situation. For instance, if you have chronic health problems, a special need plan (SNP) will be able to solve the medical cost issues. And if you need provider freedom then you may need a PPO or Private fee for service plan.

Cost-saving opportunities: There is proof that you can save money on Laboratory services and medical equipment when you switch to a Medicare Advantage plan. Also, some advantage plans don’t have cost or premium or deductibles. The next reason you should choose Medical Advantage is that there is a maximum amount of out of pocket each year.

Coordinated medical care: Most Medical Advantage plans, come under the coverage of coordinated medical care. What that means is that there is a coordinated plan by all medical care providers to give you the best service each time you visit one of them.

Pitfalls of Medicare Advantage

Medical Advantage plans have some disadvantages that original medicare does not have.

Limited service providers: If you select HMO, a popular Medical Advantage plan, you will have a limited number of medical providers that you can see. Also, you may pay higher fees if you pick an out of network provider with this plan. Also, other plans may be flexible but they may be limited and too costly.

Overwhelming plan offerings: The plans on the market for Medicare Advantage service are too many when you search through the find a medicare 2020 plan. Also, this may confuse and overwhelm buyers. But, the only saving grace, is that you can use from a checklist to reduce the number and select the one that you prefer.

Additional costs for coverage: Original Medicare bills a premium, deductible, and co-insurance for parts A and B, including any Part D or Medigap costs. But Medicare Advantage plans, add all costs into a plan. And you may see extra fees. For instance, drug deductibles and cost for visiting a specialist can accumulate over time with some Medicare Advantage plans.

State Specific Coverage: Original medicare, gives you total and continuing coverage all over the United States. But Medicare Advantage offers medical cover that is limited to your service area. What that means is that if you travel often, you may not get any coverage when you out of state services.

How do you choose the coverage plan that is best for you?

The following factors will help you choose what is best for you when you select a Medicare Advantage plan. You can decide by asking these questions and answering them. They include what type of health care coverage do you want, what are your long term health care needs and what is your budget for a month, a year for health care?.


In this post, I discussed the Medicare advantage plans available. You now  know different  types of medicare, its advantages and pitfalls of the plans.  For most Americans, Medicare Advantage Plans are great plans but if you cannot use the service, continue with the Original Medicare plan. You may also sign up for Part D plan and Medigap cover to cater to your other medical needs. Besides, you do not have to fear restrictions on any Advantage plan.

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