A lot of people get used to a certain level of coverage under their employers' health insurance plans. So when they retire and move on to Medicare, there can be some adjustments.
If you signed up for Medicare Advantage instead of original Medicare, you may have had your reasons. And they were probably good ones, since Medicare Advantage plans do offer a number of benefits.
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Medicare Advantage plans are offered by private insurers and are required to provide at least the same level of coverage as original Medicare. But many of these plans offer far more benefits, including:
- Dental cleanings and exams
- Eye exams
- Prescription eyeglasses coverage
- Hearing aids
- Fitness club or gym memberships
Plus, Medicare Advantage plans set a limit on annual out-of-pocket costs. That's huge when you're retired and may not have much wiggle room in your budget due to getting most of your income from Social Security.
But while there are plenty of things to like about Medicare Advantage, there are some drawbacks that come with signing up for these plans. Here are a few reasons to consider ditching Medicare Advantage and moving over to original Medicare instead.
1. Narrow provider networks
When you're enrolled in original Medicare, you can generally see any healthcare provider in the country who accepts Medicare. When you're enrolled in a Medicare Advantage plan, you're typically limited to a specific network of doctors and specialists. And having fewer choices could mean not getting access to the care you want or need.
Worse yet, Medicare Advantage provider networks can change from one year to the next. You might start out with a doctor you like and trust who's in your plan's network only for that same provider to be out of network the following year.
Going outside your Medicare Advantage plan's network could mean facing much higher costs. If you don't have a lot of retirement savings, that could be a problem. So if you stick with Medicare Advantage, you may find that you're limited in the doctors you can see.
2. Prior authorization requirements
It's common for Medicare Advantage plans to require prior authorization for different services. If you don't get prior authorization, your plan generally will not cover the service or treatment at hand.
The problem, though, is that prior authorization can be a bottleneck to getting care. Plus, some Medicare Advantage plans are notorious for having high rates of prior authorization denials. And while you generally have the right to appeal such a denial, once again, you could be looking at a substantial delay in your care.
3. Limited coverage for non-emergency care when you travel
The nice thing about being retired is that you're not necessarily tethered to your ZIP code. You could spend weeks at a time visiting your grown children in other states if your budget allows for it, or chase warmer weather during the winter months.
The problem with Medicare Advantage plans is that they're generally designed to cover you within your specific geographic area. If you travel outside of your coverage area, your options may be limited or nonexistent, leaving you to foot the bill for your care.
Now, the good news is that Medicare Advantage plans are generally required to cover emergency care even if you're outside of your local network. But otherwise, you may be looking at expensive costs. If you travel frequently, or intend to in the near future, then you may want to look at original Medicare instead.
Don't hesitate to make a change
Between now and Dec. 7, you have an opportunity to make changes to your Medicare coverage during the program's fall open enrollment period. It pays to consider moving away from Medicare Advantage and sticking with original Medicare if any of the issues above have been a problem for you or are expected to become an issue.
Of course, if you dump Medicare Advantage, you'll need to sign up for a Part D plan to ensure that you have prescription coverage. And you'll also want to look at a Medicare supplement plan (Medigap), which may be expensive. But if you decide that Medicare Advantage no longer works for you, you should know that you do have other options you can consider.
