Medicare Advantage enrollment has been steadily growing over the past decade. Today, over half of all Medicare beneficiaries get their coverage through Medicare Advantage Plans rather than Original Medicare. This trend is especially pronounced among older adults – in 2022, 67% of enrollees in Medicare Advantage Plans were aged 65 and over.
But why exactly are so many seniors opting for Medicare Advantage when they reach Medicare eligibility at 65? Here we’ll explore the key factors driving older adults to choose private Medicare Advantage Plans over Original Medicare.
Extra Benefits and Lower Costs
A major appeal of Medicare Advantage Plans is that they include extra coverage for services not covered under Original Medicare:
- Dental: Basic and major dental services like cleanings, fillings, crowns, and dentures.
- Vision: Annual eye exams and prescription eyeglasses or contacts.
- Hearing: Hearing exams plus hearing aid allowances.
- Fitness: Gym memberships, fitness trackers, and wellness programs.
- OTC Items: Allowances for over-the-counter medications and health-related products.
- Transportation: Free or discounted transportation to medical appointments.
- Meals: Post-discharge meal delivery and nutritional support services.
- In-Home Support: Personal care, safety monitoring, and daily living assistance services.
These extra benefits are hugely valuable to seniors dealing with declining health and mobility. And they often come with little to no added premium versus what is paid for Part B coverage.
Medicare Advantage Plans also offer annual out-of-pocket spending limits, which provides financial protection compared to Original Medicare. Many plans charge no premium beyond the Part B premium.
Provider Network and Coordinated Care
Rather than covering any provider who accepts Medicare like Original Medicare does, Medicare Advantage Plans offer or have restricted provider networks. This allows them to coordinate care better and be more selective about which doctors and hospitals are in-network.
For older adults who want care guidance and provider restrictions, Medicare Advantage offers:
- A list of approved/preferred providers to choose from
- Typically no referrals required to see specialists
- Care coordination between providers to avoid conflicts and duplication
- Often an assigned primary care doctor to oversee care
- Departments dedicated to member services and support
This more structured approach to care appeals to many older individuals who want simplified health care.
Prescription Drug Coverage
One major shortcoming of Original Medicare is that it does not cover prescription medications. Seniors must purchase separate Part D Plans for drug coverage.
In contrast, Medicare Advantage Plans include Part D by default. Health and drug coverage are integrated into one plan and often well-coordinated. Plans may offer benefits like:
- $0 copays for certain generic drugs
- Coverage in the gap after reaching the Part D spending threshold
- Mail order options with additional savings
Not having to shop for a stand-alone Part D Plan along with medical coverage is a major perk for many choosing Medicare Advantage.
Plan Choices and Stable Pricing
Medicare Advantage appeals to older individuals who want simple choices and pricing they can count on. Here’s how it simplifies options:
- Beneficiaries pick one plan that covers all services. No piecing together parts like with Original Medicare.
- Many counties have a dozen or more Medicare Advantage Plans available across insurers. This allows finding one that fits preferences at the best price.
- Prices don’t change much year to year. Seniors can often stay enrolled in one plan long term.
- If doctors leave a plan’s network, members have the option to select a new plan each year during open enrollment.
Medicare Advantage reduces the need to continually research plans and manage changing costs. Enrollees can select coverage and primarily just revisit it during each year’s open enrollment period. This simplicity and stability attracts older individuals wanting to minimize health plan management tasks.
Drawbacks of Medicare Advantage for Seniors
While Medicare Advantage appeals to many older adults, experts note some drawbacks to weigh:
Restricted provider networks – Members may not be able to see any specialist or hospital and could lose access to a trusted doctor.
Pre-approvals – Some plans require prior authorizations for tests, specialist visits, procedures. This can lead to care delays.
Harder to switch plans – Members wishing to return to Original Medicare may not qualify for Medigap coverage due to pre-existing conditions.
OOP costs – Copays and coinsurance can be high for serious conditions even with out-of-pocket maximums. Supplemental coverage is not available.
Drug formularies – Prescriptions could be denied if not on the plan formulary requiring appeals.
Travel limitations – Urgent care outside the plan’s service area may not be covered.
These factors mean Medicare Advantage may not be the right fit for every senior. Working with a health insurance counselor to understand pros and cons is recommended.
How Seniors Choose Medicare Advantage Plans
Seniors use various resources when deciding between Original Medicare and Medicare Advantage:
- Friends and family – Many choose plans based on personal recommendations. However, individual experiences often aren’t representative.
- TV and online ads – These aim to sell Medicare Advantage but don’t always provide balanced information. Important limitations may get glossed over.
- Insurance agents – Agents may favor certain insurers’ plans they get commissions for selling. Independent, unbiased guidance is preferable.
- State Health Insurance Assistance Programs (SHIPs) – Every state has counselors who give free, federally funded Medicare advice and plan comparisons.
- Medicare publications – Official handbooks outline options without promoting any specific plans. The Medicare Plan Finder tool allows customized plan searches.
Getting unbiased help through SHIPs and Medicare’s own resources can help seniors make the best plan decisions aligned with their unique health needs.
In summary, older adults choose Medicare Advantage Plans over original Medicare for several key reasons:
- Extra benefits like dental, vision and hearing coverage
- Prescription drug coverage included
- Provider networks with coordinated care
- Simple choices and stable pricing from year to year
- Lower premiums and capped out-of-pocket spending
However, the restrictions Medicare Advantage Plans come with are important to weigh against the advantages. Consulting with a SHIP counselor to understand all options is highly recommended before making a decision. But with smarter plan selections, Medicare Advantage can provide valuable coverage and stability for many seniors looking to maximize their benefits and manage costs.
We’re Here to Help
You do not have to spend hours reading articles on the internet to get answers to your Medicare questions. Give the licensed insurance agents at American Entitlements a Call at (469) 814-0289. You will get the answers you seek in a matter of minutes, with no pressure and no sales pitch. We are truly here to help.
Why do so many older adults choose Medicare Advantage?
Many older adults choose Medicare Advantage because it offers additional benefits beyond what traditional Medicare covers. Medicare Advantage Plans often include prescription drug coverage, dental and vision care, and fitness programs. These extra benefits can be appealing to older adults who want comprehensive coverage for their healthcare needs.
What is Medicare Advantage?
Medicare Advantage, also known as Medicare Part C, is a type of health insurance plan offered by private insurance companies. It provides all the benefits of traditional Medicare, but may also offer additional benefits such as prescription drug coverage, dental and vision care, and wellness programs.
How do I enroll in Medicare Advantage?
To enroll in a Medicare Advantage Plan, you must first be enrolled in Medicare Part A and Part B. During the annual open enrollment period, you can choose to enroll in a Medicare Advantage Plan instead of traditional Medicare. You can also switch from one Medicare Advantage Plan to another during this time.
What are the advantages of Medicare Advantage?
Medicare Advantage offers several advantages over traditional Medicare. These include additional benefits such as prescription drug coverage, dental and vision care, and wellness programs. Medicare Advantage Plans also often have lower out-of-pocket costs than traditional Medicare and may offer coordinated care through networks of doctors and hospitals.
What is a Special Needs Plan in Medicare Advantage?
A Special Needs Plan (SNP) is a type of Medicare Advantage Plan designed for individuals with specific health conditions or needs. SNPs provide specialized care and services tailored to the unique needs of their members. Examples of SNPs include plans for people with chronic conditions, mental health needs, or who live in a nursing home.
How do I choose a Medicare Advantage Plan?
When choosing a Medicare Advantage Plan, it’s important to consider your healthcare needs, the coverage offered by each plan, and the costs involved. You should also check if your preferred doctors and hospitals are in the plan’s network. The Medicare website and the Commonwealth Fund provide resources to help you compare plans and make an informed decision.
Can I switch from traditional Medicare to Medicare Advantage?
Yes, you can switch from traditional Medicare to Medicare Advantage during the annual open enrollment period. However, it’s important to carefully consider your healthcare needs and the specific benefits offered by Medicare Advantage Plans before making a switch.
How many older adults are enrolled in Medicare Advantage?
A significant number of older adults, aged 65 and older, are enrolled in Medicare Advantage. According to the Centers for Medicare and Medicaid Services, over one-third of Medicare beneficiaries are enrolled in a Medicare Advantage Plan.
Can I still use Medicaid services if I enroll in Medicare Advantage?
Yes, you can still use Medicaid services if you enroll in Medicare Advantage. Medicare and Medicaid work together to ensure that individuals who are eligible for both programs have access to the healthcare services they need. Medicare Advantage Plans must cover all the services offered by traditional Medicare, including those covered by Medicaid.
What is the difference between traditional Medicare and Medicare Advantage?
The main difference between traditional Medicare and Medicare Advantage is that traditional Medicare is a fee-for-service program run by the federal government, while Medicare Advantage is provided by private insurance companies. Traditional Medicare allows you to see any doctor or hospital that accepts Medicare, while Medicare Advantage Plans may have networks of preferred providers.