Saturday, October 1, 2022

Medicare Advantage vs Original Medicare (Parts A and B)

It's that time of year again for the Medicare Annual Enrollment Period, and some of you who watch cable television have been bombarded with commercials touting the benefits of Medicare Advantage plans. If so, you may be wondering why these plans are so heavily advertised and whether you should call the toll free number to sign up if you are over 65 years old.


Medicare card

I always say that a great product needs no advertising! That aside, the answer lies primarily in the way Medicare Advantage plans get funding. These plans' premiums are low or nonexistent because Medicare pays the insurance carrier whenever someone enrolls—the more the insurance companies encourage enrollment in Advantage plans, the more money they receive from Medicare!

These Medicare Advantage plans are required to include the same coverage as Original Medicare (Parts A and B). Therefore, a zero-dollar monthly premium for an Advantage plan doesn't mean you'll be getting Medicare for free—you're still responsible for your Original Medicare costs. Moreover, these plans involve managed provider networks; so, if you see a practitioner outside your network, you incur additional out-of-pocket costs.

Here are a couple of YouTube videos about Medicare Advantage plans:

And here is a summary from the American Medical Association about how Medicare Advantage plans wrongly deny prior authorization requests: https://www.ama-assn.org/practice-management/prior-authorization/how-medicare-advantage-plans-wrongly-deny-prior-auth

The bottom line: Caveat Emptor (Buyer Beware)! It may seem tempting to hastily enroll in a plan that sounds great in TV commercials, but it's important to do your research and speak to an independent Medicare agent about your specific needs to find the best health insurance plan for you. In Washington State, the Office of the Insurance Commissioner provides useful resources for free, unbiased Medicare counseling: https://www.insurance.wa.gov/get-free-unbiased-medicare-counseling-your-area.

The information provided here is not medical, insurance, tax, or financial advice. You should consult with a licensed insurance agent who sells Medicare products for advice concerning your specific situation.