Medicare Advantage Plans- Are They Really Worth It? What You Need to Know.

A lot of people ask me, “are Medicare Advantage programs worth it?” This isn’t exactly a simple question to answer. There are pros and cons to an advantage program, and it’s important you know both sides.  

Just a little back story on advantage plans- also called Medicare Replacement or Medicare Part C, they were made so that people who have Medicare Part A (hospital and Home Health) and Part B (outpatient services, such as your Doctor or Physical Therapy) can receive benefits in a different way. These plans are offered by private insurance companies that work with Medicare. I know how confusing healthcare can be, and it seems like especially this year there is a lot to keep up with! Here are a few pros/cons for this kind of Medicare program…  

Pros  

  • Your advantage plan can be a “one-stop” shop for your prescription drug coverage and health needs  
  • Many plans include dental and hearing  
  • Some plans can cost $0 a month  
  • Some plans include gym discounts  

Cons  

  • If you change to an advantage plan, sometimes some services aren’t covered (for example, physical therapy)  
  • The coverage for some services and procedures may require a doctor’s referral and plan authorizations  
  • You typically don’t receive nationwide coverage  

…so, is it worth it?  

In my honest opinion… in most cases, no. I’ll tell you why with a story.  

We had a patient once that was on a Traditional Medicare plan (not an advantage plan), and we were working with him on and off for months. He decided to switch to a Medicare Advantage plan without telling us, hoping to save money on medications. However, he didn’t realize his physical therapy wasn’t covered on his new Advantage plan. A few weeks later we realized it and we had to call him and bill him for his therapy appointments, which the advantage plan did not pay for. Remember one of the cons I mentioned earlier? If you change to an advantage plan, sometimes certain services aren’t covered (such as physical therapy). He continued therapy with us, because he knew it helped and he didn’t want to give it up and miss out on achieving his goal of taking a trip to Italy without depending on his walker! Luckily, after spending hours on the phone he was able to switch back to his traditional Medicare plan. Unfortunately, he went 3 weeks without therapy and did slide backward a little bit, but in the end, he was able to switch back to traditional Medicare and continue moving towards his goals. So, make sure you ask questions about your new coverage before making the switch to an advantage plan. 

It can be overwhelming sometimes if you’re thinking of switching your healthcare plan. That’s why I think it’s important for you to have all the information you need to come to an informed decision. You can make up your own mind on what is best for you, but if you’re asking me, I’d say stick with your Original Medicare plan!  

Are you struggling with pain/balance issues right now, and have more questions about the pros/cons of a Medicare Advantage plan? Call our clinic at 512-730-0231 to speak with a Physical Therapist about how we can help YOU TOO achieve your goal and live a healthier, more active, and independent life!   

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