If you have researched Medicare or Medicare Advantage plans, then you know the information can be confusing. Many online resources can be complicated and government resources can be difficult to understand. What’s important to realize is that no two people’s healthcare needs are the same. It is important to choose a plan that works for you. This article will discuss some of the pros and cons of using Medicare Advantage.


We at Meadowcrest Family Physicians want you to have the best access to care possible. Understanding the pros and cons of Medicare Advantage plans will help you to make a better-informed decision about your health. 


Medicare Advantage Makes High-Quality Healthcare Affordable for Seniors.


Obtaining the best health coverage is a balance between affordability and quality. It is important to research your different options. There are many options available to you when choosing a medicare advantage provider. Each of these providers have different plans to fit your individual needs. 


Meadowcrest Family Physicians accepts Medicare Advantage Benefits. This means by switching to a medicare advantage plan, you will still be able to receive the same quality care and not have to find a new provider. 


This means keeping your same doctor and standard of care for less cost to you. Out-of-pocket costs are capped with Medicare Advantage plans. This better allows you to plan and budget for their future. 


Individuals Eligible for a Special Needs Plan (SNP) can Switch Outside of Open Enrollment


Medicare Special Needs Plans (SNPs) are a type of Medicare Advantage Plan that serves patients with chronic and ongoing conditions. 


Special needs plans have no open enrollment periods to ensure these individuals receive the care and prescription medication they need. If you are eligible and need to switch to a Special Needs Plan you can do so anytime without penalty.


For more information about Special Needs Plans check out our article here.


Why Some Patients Think Twice About Medicare Advantage Insurance Plans

Each person’s healthcare needs are unique and no medicare plan is one size fits all. Some Medicare Advantage plans offer benefits not needed by every patient.


This can lead you to pay for benefits that you might not need, increasing your monthly premiums. Those with high prescription drug costs also may run into a coverage gap known as the Medicare Advantage Donut Hole. 


Some sources list reasons why medicare advantage plans are bad. While there are plenty of myths surrounding Medicare advantage,the truth is that you need a healthcare plan that works for you and the way you live – and a Medicare Advantage play may or may not be a good fit. Either way, you should explore your options before making any decisions regarding your coverage. 


The Medicare Advantage Donut Hole Affects Those With High Prescription Drug Costs.


The coverage gap also known as the “donut hole” refers to a limit to how much a drug plan will pay for prescription medications after a certain amount. The coverage gap begins after a member and their drug plan have spent $4,660 on covered drugs in 2023. 


Exceeding the covered amount is not a complete deal breaker for many individuals and may still be the best choice. Once the member and their drug plan have spent $7,400 out-of-pocket on covered drugs they will automatically get ‘catastrophic coverage’.


This coverage assures the member only pays a small coinsurance percentage or copayment for covered drugs for the rest of the year.


With Medicare Advantage, the Member is Generally Subjected to a Plan’s Care Network. 

This means you must get your care from doctors, and hospitals in the plan’s network. There are exceptions for emergency and out-of-town care to make sure you always have options to ensure the best care.


For those currently seeing a doctor that does not take medicare advantage, switching to a new physician could be undesirable. 


Having a relationship with a doctor you trust can make a large impact on someone’s health and happiness. Going to see a doctor at a new clinic can be a very daunting experience. It is important to find a healthcare plan that works “just right” for you.


If you are already a patient with Meadowcrest Family Physicians and you are thinking of switching, we accept Medicare Advantage plans. So you will still receive the same care from the same doctor at our practice if you choose to switch.


Coordinated care plans are ideal for improving your health


Medicare wants to be sure that all doctors have the resources and information they need to coordinate their care. Coordinated care within a plan’s care network helps prevent:

  • Getting the same service more than once (when getting the services again isn’t needed)
  • Medical errors 


Medicare Advantage Networks Have Increased Coverage Requirements Compared To Standard Medicare.


Medicare Advantage Plans are administered by private insurance companies in contract with the federal government. 


While these Health Management organizations (HMOs) and Preferred Provider Organizations(PPOs) have limited provider networks, they are required by law to have increased coverage requirements compared to standard Medicare.


At Meadowcrest Family Physicians we recommend Medicare Advantage if it provides the coverage you need. 


After many years of serving patients with Medicare Advantage, We have found that our many individuals are getting better benefits with Medicare Advantage Plans. You should continue to explore your Medicare Advantage options if you are looking for added coverage. At Meadowcrest Family Physicians, You can be certain that your medicare benefits will be accepted and you will continue to receive the care you deserve.