You’ve seen the flyers and the commercials. Medicare Advantage plans offering you all these benefits at $0 per month? Is it a scam? The answer may surprise you!
What is Medicare Advantage
Medicare Advantage plans are an alternative to Original Medicare. They are not to be confused with Medicare Supplement Plans aka Medigap Plans which work with Original Medicare.
Medicare Advantage plans are offered by private carriers and they may be similar to the health insurance that you’ve had in the past. They are not standardized but must offer at least the same benefits as Original Medicare.
Plans claim to offer all these benefits. Is that really true?
Actually, very often, yes, it is true! Plans will often offer benefits such as:
- Dental
- Vision
- Hearing
- Prescription Drug
- Transportation
- Fitness
- Worldwide Emergency
- Telehealth
- OTC Drugs
- In Home Support
- Home Safety Devices & Modifications
- Emergency Response Devices
- And MORE
But, these benefits definitely come at a cost. Although, the cost may not be what you expect!
Are they Free?
So, are these plans really free? While many plans claim to be free that’s not exactly true. At the very least you’ll have to pay for your Part B.
But for many plans, there is no additional cost. If this is sounding too good to be true and a little scammy, we’ll get to that in just a bit!
But, how are these plans offered at no cost?
Well to Original Medicare, you are considered a risk! And they are willing to pay Medicare Advantage plans a set amount to take on that financial risk. Basically, Medicare is looking to pawn you off on a private carrier.
But Medicare Advantage Plans are not just doing that out of the kindness of their hearts. Let’s talk about the parts that don’t make it into the commercials and brochures.
Downsides
When things sound too good to be true, alarm bells go off! While Medicare Advantage plans but not exactly a scam, many people feel that they were misled about their Medicare Advantage plans. And that is for two main reasons.
Networks
Medicare Advantage plans are offered by private carriers and have networks. These networks can be extremely restrictive because many doctors and hospitals simply don’t like working with Medicare Advantage plans.
We’ll discuss why that is in just a moment.
Medicare Advantage plans offer HMOs and PPOs. Even still, many people report difficulty finding doctors (especially specialists) who accept their plans. Some people have to travel hours to find someone in the network.
Preauthorization
And why don’t so many doctors and hospitals work with Medicare Advantage plans? Yes, they may contract at a lower rate, but so does Original Medicare and almost all doctors and hospitals accept Original Medicare.
MA plans are managed care plans. So, there are barriers regardless of whether you have an HMO or a PPO.
Basically, your insurance has to pre-authorize your treatments or services even if your doctor has approved them. Some carriers are better than others, but you could be denied or certainly put through the wringer with paperwork to get your medical care approved.
Doctors don’t like this and patients don’t like this either.
So, is it a scam? Not really. But it may not be all it’s made out to be either. Read your terms carefully. Work with a broker. And proceed with caution!
Read more on Top 3 Medicare Advantage Nightmares!
or
Read more on our take on Medicare Advantage and LIES!
Jesse Smedley is the Principal Broker for iHealthBrokers and the founder, president, and CEO of Smedley Insurance Group, Inc. and iHealthBrokers.com. Since the inception of SIG in 2007, Jesse has been dedicated to helping people save money on their health insurance by providing them with resources to educate themselves on all their health insurance options, both under age 65 and Medicare beneficiaries. He is featured in many publications as well as writes regularly for expert columns regarding health insurance and Medicare.
