At this point, there are only a few weeks left before Medicare's fall open enrollment period comes to an end. If you haven't put your coverage in place for 2025, now's the time to get moving.
During open enrollment, you can switch from your current Medicare Advantage plan to a new one. Or you can drop Medicare Advantage and move to original Medicare.
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You may be inclined to stick with Medicare Advantage in one shape or form, and there can be benefits to doing so. One nice thing about the program is that it limits your out-of-pocket spending. When you're retired and on a fixed income, that's huge.
Granted, with original Medicare, you can buy protection in the form of a Medigap plan. But you may prefer to know that your healthcare costs for the year can't exceed a certain threshold.
Medicare Advantage also commonly offers supplemental benefits on top of what original Medicare will pay for. The Kaiser Family Foundation (KFF) reports that in 2024, 99% of Medicare Advantage plans offer vision benefits, while 98% offer dental care.
Despite these perks, you may want to look outside of Medicare Advantage for your 2025 coverage. Here are a few reasons why.
1. You might lose access to your trusted providers
Medicare Advantage might seem like a great form of health coverage for seniors, but many providers and hospital networks are cutting ties with Medicare Advantage. The reasons for this include high rates of patient claim denials, cumbersome prior-authorization requirements, and holdups on reimbursements.
If you have a core team of providers you trust to manage your care, you may find you're not able to retain access to them as a Medicare Advantage enrollee. Moving to original Medicare might give you access to more doctors and hospitals in your area.
2. You might end up paying for benefits you don't need or use
The KFF reports that in 2024, 75% of Medicare Advantage plan enrollees with prescription drug coverage don't pay a premium other than the cost of Part B. But some Medicare Advantage plans come with sizable premiums that may not be worth the cost. If you're paying a lot, it's time to reevaluate.
It may be that you're paying up for a Medicare Advantage plan that offers a host of extra benefits, from meal delivery to home cleaning. But if you're not using those benefits or aren't eligible to use them because you don't qualify for a health-related reason, you may be throwing your money away.
In that case, you could seek to switch to a $0 premium Medicare Advantage plan. However, you may find that your total costs are still higher when you account for expenses outside of plan premiums.
3. You might have trouble splitting your time between states
It's not uncommon to adopt a snowbird lifestyle in retirement or split your time between different parts of the country for non-weather-related reasons. The problem with Medicare Advantage is that it limits you to a specific network of providers. If you spend a lot of time out of state, you may find that it's difficult -- or costly -- to get coverage.
Don't assume that access to telehealth will solve the problem. In some cases, there may be rules that prohibit providers from providing care to patients who are out of state -- even though, in theory, it shouldn't matter whether you're logging into a healthcare visit from South Carolina, Ohio, or Arizona.
There are definite perks to enrolling in Medicare Advantage. But before you decide to sign up for a Medicare Advantage plan in 2025, consider the pitfalls you might encounter, and figure out whether original Medicare makes more sense for you.
