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Avoid These Pitfalls When Considering a Medicare Advantage Plan

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Recent data tells us that almost half of all Medicare beneficiaries have chosen Medicare Advantage plans. But why are Medicare Advantage plans so popular? Is it just aggressive marketing, or is something else happening in the Medicare marketplace that is attracting seniors to Medicare Advantage coverage?

With open enrollment now underway, we’re taking time each week here on the Blog to examine information you can use to make you a wiser Medicare consumer. This week we offer this recent NerdWallet article in which reporter Kate Ashford examines Medicare Advantage policies with an eye toward helping you avoid the pitfalls and make a smarter buying decision.

The bottom line seems to be that, while Medicare Advantage plans can be a good choice for some, there’s a lot of misinformation out there that causes people to buy these policies without doing their homework. Let’s see what Ashford is referring to.

Medicare Advantage Policy Holders Spend Too Much?

Ashford begins her article with a familiar statistic: most Medicare beneficiaries ignore open enrollment entirely.

She writes, “Only 3 in 10 Medicare beneficiaries shop around during open enrollment, according to a 2022 analysis from KFF, a health policy nonprofit — and only 1 in 10 Medicare Advantage enrollees voluntarily switch plans. But a 2020 analysis of Medicare Advantage plan choices by the National Bureau of Economic Research found that more than half of beneficiaries overspent by more than $1,000 due to the plan they selected.”

As we noted, Medicare open enrollment started October 15th and continues through December 7th.  It’s the one penalty-free period when those on Medicare can change plans for the upcoming year. It’s also a time when the marketing machinery for Medicare Advantage plans really ramps up.

“Although potential Medicare Advantage enrollees may be swayed by $0 premiums and extra perks like vision and dental coverage, there are more important features to explore when you’re choosing next year’s coverage,” says Ashford. “Here are some practices to avoid as you shop for Medicare Advantage this fall.”

Don’t Confuse Medicare Advantage with Medicare

“If you’re considering Medicare Advantage,” Ashford writes, “understand that it’s not the same thing as government-provided Medicare. It offers the same benefits, but Medicare Advantage is run by private health insurance companies and it operates differently.”

(NerdWallet recently published a pair of articles providing a basic description of Medicare Advantage plans as contrasted with traditional Medicare. They’re worth a look.)

“You are essentially taking the Medicare coverage that you’ve been provided by the government and turning that in,” Melinda Caughill, co-founder and CEO of 65 Incorporated, which offers Medicare guidance, told NerdWallet.

“You can switch back to Original Medicare during each year’s open enrollment period, but you may not be able to qualify for an affordable Medicare Supplement Insurance, or Medigap, plan once you’re past the one-time Medigap open enrollment period,” Ashford explains. Medigap coverage is critically important since these plans cover certain out-of-pocket costs not covered by Original Medicare.

Don’t Assume Your Doctor is Part of a Medicare Advantage Plan

If you like your doctor, be very careful when choosing a Medicare Advantage plan. As NerdWallet explains, these plans “operate within networks of medical providers, and you usually must see in-network doctors for covered care.”

Ashford spoke to Emily Gang, CEO of Medicare Coach, a site that offers Medicare guidance. “A lot of people don’t realize that — especially those $0-premium plans — they tend to have fairly confined networks,” said Gang. “You want to double-check that your doctor is actually an approved provider in that network.”

One easy solution is to ask your providers what insurance they’ll be accepting in 2024. That can be easier than trying to check each plan’s network individually.

Medicare Advantage Drug Coverage Subject to Change

“Like network providers, Medicare Part D prescription drug coverage can also change each year,” Ashford writes. “Your drug plan might cover one of your medications differently in 2024, leaving you with more out-of-pocket costs than you expected.” (We wrote about researching Part D plans last week here on the Blog.)

Medicare adviser Caughill says that the more you rely on prescriptions, the more is at stake. “If you take even one brand name medication, your need to compare plans is incredibly high,” Caughill says. Even if there are no brand names on your list, shop around, especially if you take five or more medications. Shifting drug coverage might be a reason to switch Medicare Advantage plans.

Don’t Buy Medicare Advantage Just for Extra Benefits

Often, Ashford observes, buyers are drawn to MA plans because of the extras – but they might not represent such a great deal. “Medicare Advantage plans usually include benefits that aren’t part of Original Medicare, such as dental, vision or hearing coverage,” she writes. “These extras may be appealing, but don’t let them steer your plan choice.”

Don’t forget, one expert told NerdWallet, that the critical need is to insure your health, not to get a lot of extras. “First of all, it’s health insurance — so how is it going to cover your health care providers and your medications?” says Katy Votava, president and founder of the Medicare consulting firm Goodcare. “If you pick [your plan] for a benefit that isn’t health insurance, you’re often picking wrong. And the dental benefit is pretty limited in all these plans — it’s a couple of cleanings and some bite wings.”

Considering Medicare Advantage? Look Beyond the Premium

“Free coverage” might sound enticing, says NerdWallet, but be careful. “The majority of Medicare Advantage enrollees are in plans with no premium,” says Ashford, “meaning you pay nothing each month for the plan.”  As Emily Gang of Medicare Coach put it, “People see that $0 premium and they’re like, ‘Oh, it’s free.’ And it’s not.”

Before you sign up, Ashford emphasizes, research the rest of the costs of the plan. These include deductibles, copays, coinsurance and the out-of-pocket maximum, which is the most you might have to spend on covered care in a year. “In 2023, the out-of-pocket max can be as high as $8,300 for in-network care,” says the article. Other plans offer much less out-of-pocket risk, but with higher premiums.

Don’t Choose Medicare Advantage Because Your Friend Did

No doubt about it, the marketing blizzard makes people exhausted. “People eligible for Medicare are bombarded by information during open enrollment, and it can be overwhelming,” Ashford acknowledges. As Goodcare’s Votava told NerdWallet, “They don’t shop.  They go with name recognition or what their friend has.”

“The better choice,” says Ashford: “Focus on your own situation and find the plan that meets your needs.” If you need help, NerdWallet recommends contacting State Health Insurance Assistance Program, or SHIP, in your area for free Medicare guidance. (In Washington State the office is called SHIBA: the Statewide Health Insurance Benefits Advisors.)

But if you decide to reach out for assistance, do it soon, because appointments fill up. As Votava says. “If you need individual help, you’d better get on the list.”

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(originally reported at

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