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Tag: Medicare Advantage

Why do some seniors choose Medigap over Medicare Advantage?

Andy |
Medigap
Medigap offers the type of flexibility that some seniors may find is worth the higher price tag.

As Medicare open enrollment kicks into high gear, millions of older adults are taking a fresh look at their health insurance options. For many, that means deciding between sticking with or switching to either a Medicare Advantage plan or a Medicare supplemental insurance policy, also known as Medigap. It’s a choice that can shape not just monthly budgets but also how easily seniors can access the care they need.

At first glance, Medicare Advantage plans may seem like the obvious choice. Many offer low or $0 monthly premiums and bundle extra perks like dental, vision and hearing coverage. For retirees living on fixed incomes, those features can be appealing. But despite the popularity of Medicare Advantage — 54% of all Medicare beneficiaries are enrolled in these plans — a significant share of seniors continue to rely on Medigap coverage instead.

So what drives some seniors to choose Medigap coverage over Medicare Advantage plans? That answer typically comes down to what people value in their healthcare coverage. Below, we’ll break down what to consider.

Why do some seniors choose Medigap over Medicare Advantage?

Medigap plans work alongside Original Medicare, covering many of the out-of-pocket costs that traditional Medicare doesn’t, like deductibles, coinsurance and copayments. Medicare Advantage plans, on the other hand, replace Original Medicare with a private insurance plan that often comes with its own rules, networks and cost structures. Here’s more on why many older adults opt for Medicare supplemental coverage over Medicare Advantage plans:

Access to a wider network of doctors and hospitals

One of the main reasons seniors opt for Medicare supplemental coverage is the flexibility to see any doctor or specialist who accepts Medicare, anywhere in the nation. There are no restrictive provider networks or referral requirements. For retirees who travel frequently, live in multiple states or simply want to keep their existing doctors, this nationwide access can be a major advantage.

Find out how Medigap can help fill in your Original Medicare coverage gaps today.

More predictable costs over time

While Medigap plans typically have higher monthly premiums than Medicare Advantage plans, they tend to offer more stable and predictable out-of-pocket expenses. Depending on the plan type, like Plan G or Plan N, Medigap may cover nearly all of the costs left over after Medicare pays its share. For seniors managing chronic conditions or anticipating regular medical visits, that type of coverage predictability can be invaluable.

Fewer administrative hurdles 

Medicare Advantage plans often require beneficiaries to obtain prior authorizations before they can be approved for certain treatments or services, and these hurdles can sometimes lead to delays or denials for otherwise necessary medical care. Medigap paired with Original Medicare typically doesn’t have these barriers, though, which makes it easier to access care when you need it.

Stable benefits year after year 

While Medicare Advantage plans can change their provider networks, cost-sharing rules and benefits annually, Medicare supplemental plans are standardized and don’t change once you enroll. That type of stability can make long-term financial planning simpler and reduce the risk of unexpected coverage shifts.

How to decide between Medicare supplemental coverage and Medicare Advantage

Both Medicare Advantage and Medigap have clear benefits and tradeoffs and the right choice often depends on your health needs, financial situation and lifestyle. Here’s what to weigh as you’re deciding which coverage option makes the most sense for your needs:

Consider your healthcare usage 

If you visit doctors frequently, need specialist care or expect ongoing medical costs, Medigap’s more comprehensive coverage may make sense. On the other hand, if you’re relatively healthy and want to minimize monthly premiums, a Medicare Advantage plan could be more cost-effective.

Think about where you receive care 

Seniors who split time between states or travel often may benefit more from Medigap’s nationwide coverage. But if your care is primarily local and your providers are in-network, Medicare Advantage could work well.

Weigh long-term costs carefully 

While Medigap premiums can rise with age, Medicare Advantage plans can also change cost structures each year. Some seniors start with Advantage plans for the lower premiums and switch to Medigap later. However, in many states, switching to Medigap after your initial enrollment period may require medical underwriting, and you could be denied coverage or face higher premiums if your health has changed.

Factor in extra benefits 

Medicare Advantage plans often offer extras like dental, vision, fitness memberships or transportation services. If these are important to you, they might tilt the balance toward Medicare Advantage. Medigap focuses primarily on covering medical costs rather than additional perks.

The bottom line

When choosing between Medicare Advantage and Medigap, there’s no universal answer for retirees. Medigap appeals to many seniors because of its flexibility, predictable costs and stable coverage, while Medicare Advantage can be more affordable for those with limited healthcare needs or who value additional benefits.

When weighing your options during open enrollment, be sure to assess your health, budget and lifestyle carefully. By understanding the potential benefits and downsides of each option, you can select the coverage that best fits your unique situation and ensures you have the care you need at a cost you can manage.

Would you like more information on a Medigap plan?

www.AZhealth.us

Andy Orlikoff

623-742-3878

Should You Ditch Your Medicare Advantage Plan? Most People Do

Andy |

If you’re tempted to ditch your Medicare Advantage plan, you’re not alone. Here’s when it’s a good idea and how to go about it.

BY

A young female medical doctor is meeting with a senior female patient. She is smiling as she is looking at her patient.

Medicare coverage doesn’t just mean signing up for government insurance. In fact, more than half of Medicare recipients now get their coverage through a Medicare Advantage plan, or Medicare Part C plan, which is offered by a private insurer.

Advantage plans are an alternative to original Medicare, replacing Part A (hospital coverage), Part B (outpatient care coverage), and sometimes Part D (prescription drug coverage).

Enrollment in these plans is expected to grow to 60% of the eligible population by 2030, with many people drawn to them because they’re often marketed as “zero premium” plans with out-of-pocket limits, while Medicare Part B has uncapped spending and charges premiums. The Trump administration strongly favors the expansion of Medicare Advantage plans.

Yet, while Advantage Plans seem like a good alternative, a substantial number of older Americans who sign up for them don’t stick with them. In fact, among those who signed up between 2011 and 2022, around half left their plans within five years.

Recent research published in the journal Health Affairs helps demonstrate why so many are opting out of their Advantage Plan during open enrollment, either by switching to a different Part C plan or by returning to traditional Medicare instead. Since these Advantage plans are less likely to attract beneficiaries over the long term, the study warns that such plans will likely have less incentive to cater to participants with chronic conditions.

Should you ditch your Medicare Advantage plan? Why others are

Researchers sought to gain insight into why Medicare Advantage participants were disenrolling by using information from the Medicare Current Beneficiary Survey, linked with data on Medicare Advantage enrollment. The survey measures patient satisfaction with access to medical care, as well as the cost and quality of the care they receive.

Researchers found two primary factors drove departures from Medicare Advantage plans, and neither was related to cost. Instead, most people who disenrolled did so because of difficulty accessing care as well as concerns about the quality of their care.

Access issues, in particular, were especially likely to prompt Advantage customers not just to switch to a different Medicare Part C plan but instead to return to traditional Medicare. This makes sense, given that traditional Medicare doesn’t impose the same limits as Advantage Plans on which doctors or care providers patients can visit.

Hospitals have also been ending their affiliations with Medicare Advantage Plans, creating huge problems when break-ups happen outside of the open enrollment period, and Advantage Plan customers suddenly find themselves without coverage at the hospital where they’d been treated.

Researchers also revealed that individuals with health issues were more likely to switch out of their Medicare Advantage plan. Those who described themselves as being in poor health were:

  • More than twice as likely as other Advantage members to express difficulty with getting care;
  • More than three times as likely to be dissatisfied with the quality of care they are getting
  • More than twice as likely to be unhappy with the cost of their care
  • More than twice as likely to be dissatisfied with their specialty care.

“People who stay in [Medicare Advantage} are shopping for better service, but … those who switch to traditional Medicare are the ones potentially with high health care needs, who are much more strongly driven by dissatisfaction with access to care issues ” said Geoffrey Hoffman, Ph.D., Associate Professor, U-M School of Nursing and one of the study’s authors.

This tendency to switch between Advantage plans or back to original Medicare could undermine the long-term effectiveness of these plans while also driving up the nation’s cost to provide original Medicare. The study warns that Advantage plans will likely focus on the short-term healthcare needs of beneficiaries due to plan hopping.

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