Thinking about Joining Medicare Advantage?

If you have Medicare, this time of year always brings an opportunity to switch health plans during the annual open enrollment period, which starts this weekend and runs through December 7. About 30% of Medicare participants choose Medicare Advantage plans—the private plan  alternative to traditional or “original” Medicare. Medicare Advantage plans offer the same benefits as those covered under traditional Medicare, but they also differ in significant ways. So, today’s WatchBlog explores some issues to consider when choosing a Medicare plan. Simplicity, financial protection, and extras There are a number of aspects of Medicare Advantage plans that participants find appealing, including:

• All-in-one coverage. Unlike traditional Medicare, most Medicare Advantage plans cover prescription drugs, so enrollees don’t need to purchase a separate drug plan (with a separate premium).

• Lower out-of-pocket costs. Total out-of-pocket costs for covered services are capped in Medicare Advantage—and once the annual cap is reached, the plan pays the full allowed amount for your medical services. Moreover, by joining a Medicare Advantage plan, you can save money by dropping “medigap” if you have it—supplemental insurance that covers some costs such as co-payments or care outside of the United States. Some Medicare Advantage plans also help enrollees pay their monthly Medicare premium.

• Extra benefits. Medicare Advantage plans typically offer benefits not covered under traditional Medicare, such as dental, hearing, and vision care. Some plans even offer gym memberships.

Premiums, provider restrictions, and flexibility However, there are also some components of Medicare Advantage plans that might not appeal to all traditional Medicare participants, including:

• Premiums. People in Medicare Advantage plans may have to pay a separate monthly premium in addition to their Medicare premium.

• Restricted choice of providers. People in Medicare Advantage plans generally must choose their doctors and hospitals from a specific network of providers—and out-of-network services can be costly. Yet, studies have shown that information about provider networks can change frequently, making it hard to know who is in network. We have recommended ways that oversight of Medicare Advantage networks can be improved.

• Limits on flexibility. Once you join a Medicare Advantage plan, there is a 6-week period during which you can return to traditional Medicare. After that, you can only switch once a year during the open enrollment period. Furthermore, you may face difficulty buying a “medigap” policy from a private insurer after you return to traditional Medicare.

Weighing the pros and cons If you’re eligible for Medicare and interested in Medicare Advantage, you should closely review the pluses and minuses of the two programs. Medicare offers resources, such as the handbook Medicare & You, as well as a list of state health insurance counselors you can contact to learn more. If Medicare Advantage appeals to you, you likely have many plans to choose from in your area, each with somewhat different benefits, costs, and quality. A good starting place for comparing plans is the Medicare Plan Finder.

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• Questions on the content of this post? Contact James Cosgrove at CosgroveJ@gao.gov.
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