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Top Disadvantages of Medicare Advantage Plans - YouTube
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welcome to medicare school daily where
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we help you understand medicare save
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money avoid mistakes and above all else
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get the most out of your medicare
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benefits as you probably know when
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someone is eligible for medicare and
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they're ready to take their medicare
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benefits there's only two types of
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insurance that are available one of
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those types of insurance would be a
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supplemental plan that supplements
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original medicare the other one is
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called an advantage plan or a
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replacement plan and when you go on
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medicare you have to choose one or the
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other now half of all the americans are
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on supplemental plans and have their own
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advantage plans so one is not better
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than the other they're just different
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and today's topic is i want to address
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three disadvantages of advantage plans
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now there are a lot of advantages to
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advantage plans namely two i'll tell you
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about the disadvantage here in just a
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second but first off why do people like
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advantage plans today well number one
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they like them because of the monthly
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premiums are very very low in fact on
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the high side someone may pay maybe 49 a
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month for an advantage plan but normally
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it's more on the low side here either
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zero or very low premiums so that's a
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nice feature the other reason people
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like advantage plan is because all the
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perks that they throw in that are
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typically not available with the
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supplemental plan those perks would be
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things like dental benefits okay
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vision benefits
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also sometimes the plans throw in some
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hearing benefits maybe even hearing aids
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and then also gym memberships called
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silver sneakers and so these are very
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nice perks and so when people look at
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advantage plans sometimes they're very
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attracted to these uh particular uh
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aspects of their advantage plan okay and
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so they buy an advantage plan primarily
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for that especially if they're healthy
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and so these are great perks but we also
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want you to understand there's also some
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things that are on the negative side
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advantage plans not trying to frighten
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you from them not trying to steer you
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away from them but you need to be aware
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of these disadvantages because many
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times agents aren't honest about these
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particular disadvantages so let's go
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through these disadvantages number one
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will be networks if you decide to get a
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supplemental plan you have no networks
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medicare is your network any provider
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that takes medicare you can go to that
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provider any hospital doctor specialist
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okay but when it comes to an advantage
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plan you will always have networks there
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are two types of networks hmos and ppos
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hmo networks are typically a little
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smaller than ppos
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hmos have certain restrictions that ppos
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may not such as referrals required and
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you can't go out the network but anytime
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you have advantage plan you have to make
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sure that your providers are going to be
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in the network that you can go to the
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doctor that you choose or the specialist
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that you choose or the hospital that you
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choose now listen there's no doctor or
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hospital or specialist going to take all
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of these plants at all some will take an
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hmo some will take a ppo and sometimes
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they'll take both but you got to make
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sure your providers are within the
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network because you have these network
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restrictions the second disadvantage
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would be
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pre-certifications pre-certification
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what's that mean that means that the
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doctor has ordered an mri or maybe a cat
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scan or maybe is saying that you need a
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hip replacement or knee replacement and
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that is going to have to be
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pre-certified now every service that you
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have on the advantage plan does not have
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to be pre-certified you can go to your
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primary care doctor you can go to a
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specialist there's lots of things you
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can do without a pre-cert but there are
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some times a pre-certification will be
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required on your advantage plan now if
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you stay in original medicare with the
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supplemental plan there's never a
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pre-certification medicare and your
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doctor make all the rules your doctor
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has a final say-so when you have an
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advantage plan on certain services your
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doctor does not have the final say-so if
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doc is suggesting something that
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requires a pre-certification they're
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going to have to call the advantage
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company and they're going to have to get
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that pre-approved just recently we had a
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lady that
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was needing a hip replacement total hip
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replacement is what doctors suggested
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she was on advantage plan and the
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advantage plan said no we're not going
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to pay for a full hip replacement you
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can use a rod instead we had a lady
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recently who was also needing hip
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replacement advantage plans said you
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must go to therapy for nine months after
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that if you still need a hip replacement
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then we'll discuss that i had someone
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again recently uh needed an mri in those
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back has chronic back pain they couldn't
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figure out what it is or is the mri and
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evangeline said no go to therapy three
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weeks call us back after that and so the
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whole point is they have a say so in
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your health care it's not just your
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doctor to make the final decisions the
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plan also has uh some say-so in uh what
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is going to happen with your health care
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okay and some people are just annoyed by
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that and so you need to be aware of then
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lastly switching plans now every year
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medicare has an open enrollment period
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this is october 15th to december 7th and
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many people think because we have this
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open enrollment period that folks can
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switch plans and change and just do
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whatever they want without any rules and
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that's not true
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if you're on an advantage plan and let's
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say that you would like to switch to a
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supplemental plan and get off of that
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advantage plan
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do you realize folks that after you have
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been on advantage plan one year anytime
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after one year if you want to make that
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switch
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you have to be approved
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by
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that insurance company to make the
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switch okay meaning you're gonna have to
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go through underwriting
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the insurance company is going to ask
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you 20 to 25 health questions they're
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going to check your medications to see
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what you're being treated for and
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they're also going to possibly get a
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statement from your doctor we call it an
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attending physician statement so you may
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have to get that statement from your doc
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and so the whole point is an underwriter
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is going to have to approve you to make
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that switch so so many people think they
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can just switch and do whatever they
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want but after you've been on advantage
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plan one year to make the switch to a
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supplemental plan you'll have to
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medically qualify so these are some
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features that you have to live with yes
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there's some nice perks and the premiums
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are very low but you also have to be
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comfortable with these situations well
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if you decide to choose a medicare
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advantage plan for your coverage thanks
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so much for watching
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to learn more watch the related video or
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check out our most recent video also be
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