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Are People Happy With Their Medicare Advantage Plans? Pros and cons of Medicare Advantage

December 01, 20236 min read

Medicare Advantage Plans now provide coverage for over 28 million Medicare beneficiaries - representing more than half of the total Medicare population. With swelling enrollment numbers, a common question is whether or not people are actually satisfied once receiving medical care through their Medicare Advantage Plan.

Overview of Medicare Advantage Plan Enrollment

Since the Medicare Modernization Act of 2003 introducing Medicare Advantage, enrollment has climbed steadily each year. Reasons for the growing shift from Original Medicare include:

  • $0 premium plans with Part D drug coverage included

  • Added dental, vision and hearing benefits unavailable through Original Medicare

  • Perceived simplicity of having medical and drug coverage combined under one insurer

The convenience and expanded benefits prove appealing, ensuing the spike from just 13% enrolled in Medicare Advantage Plans in 2004 to 56% enrolled in 2023.

Overall Satisfaction Reported by Medicare Advantage Enrollees

With over 26 million now participating in Medicare Advantage, the logical question is how happy are beneficiaries with their plan choices?

Annual surveys by organizations such as JD Power, Commonwealth Fund, and Kaiser Family Foundation reveal:

  • Over 85% satisfaction on average when asked to rank their Medicare Advantage Plan

  • 70% indicate Medicare Advantage provides better overall value than other Medicare options

However, experts caution that reported satisfaction varies:

  • Across Individual Medicare Advantage Plans

  • Dependent on enrollee health status

  • Research done beforehand to select optimal plans

Pros of Medicare according enrollees

Digging deeper into drivers of satisfaction, enrollees highlight aspects including:

Lower Costs Than Supplement/Medigap Plans

  • $0 premium plans with capped out-of-pocket maximums around $5000 provide cost predictability appreciated by enrollees on fixed incomes.

  • Medigap premiums often cost $150+ monthly excluding drug benefits altogether.

Extra Benefits Lacking in Original Medicare

Coverage for routine dental cleanings, vision exams and hearing aid discounts please Advantage members since Original Medicare excludes these.

Care Coordination and Easier Provider Access

Having a dedicated primary doctor arranging specialist referrals and hospital/facility access is valued - avoiding Traditional Medicare's open-ended fragmentation.

Cons of Medicare Advantage: Beneficiary Report

Alternatively, scenarios causing occasional member displeasure include:

Limited Provider Networks and Specialist Choice

Restricted doctors/hospitals covered coupled with primary care gatekeeping limiting specialist access frustrates some with pressing treatment needs.

Higher Costs for Out-of-Network Care

Paying 30-50% coinsurance for visiting non-contracted providers due to network restrictions presents difficulties despite capped out-of-pocket thresholds.

Prescription Preferences Not Covered

Upon needing expensive biologics or rare disease specialty medications, some discover their specific drugs aren't included requiring disruptive appeals or paying full cost.

Variability in Satisfaction Based on Health and Plan Choice

While the majority convey positive Medicare Advantage Plan experiences, satisfaction degrees diverge regarding:

Health Status Variances

  • Healthy members seldom accessing medical services report higher satisfaction on surveys versus high-need patients encountering plan limitations.

Research Patterns

  • Those putting in effort to understand options and select optimal plans have much higher satisfaction than individuals passively enrolling.

Plan Quality Differences

  • Low quality plans with worst-in-industry records for access, treatment approvals and complaints significantly trail top tier plan satisfaction marks.

Switching Between Medicare Options

Dissatisfaction manifests with 1 out of 5 Medicare Advantage members migrating back to Original Medicare within 2-3 years. Reasons include:

  • Facing a new complex condition requiring specialized care.

  • Moving to a geography with fewer Medicare Advantage Plan options

  • Benefit changes or premium hikes enacted by the plan.

This churn persists mostly during Annual Enrollment or upon healthcare triggering events allowing movement back to Original Medicare.

Ongoing Factors Impacting Satisfaction

Because Medicare Advantage Plan details fluctuate annually, satisfaction involves regularly re-verifying appropriate coverage.

Annual Plan Changes

Each year plans make adjustments involving networks, drug formularies, treatment needs requiring prior authorizations and benefits offered. This indirectly alters care access and out-of-pocket costs plan members bear.

Health/Healthcare Priorities

Evolving medical requirements as one ages warrants rechecking Medicare Advantage Plan details so gaps don't inadvertently emerge.

Ongoing Option Exploration

Proactively running Plan Finder comparisons identifies solutions better matching updated personal situations - especially valuable for those facing common conditions like diabetes, arthritis and cancer.

In summary - selecting a suitable Medicare Advantage Plan aligned with health priorities and vigilantly ensuring coverage keeps pace with changing needs is instrumental for satisfaction over the long haul.

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 Brexden Insurance a Call at (870) 919-7177. 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.

Frequently asked questions

What is the difference between Medicare Advantage and Traditional Medicare coverage?

 Traditional Medicare coverage includes Medicare Parts A (hospital insurance) and B (medical insurance), while Medicare Advantage (Medicare Part C) includes all benefits of Parts A and B plus additional services like prescription drug coverage and health insurance for hearing, vision, and dental. Medicare Advantage Plans often provide a more comprehensive coverage than traditional Medicare beneficiaries receive.

Can you provide some information about Medicare Advantage Plans?

 Medicare Advantage Plans are offered by private insurance companies like Blue Cross Blue Shield that contracts with the government. These plans include all benefits covered under Medicare Part A and Part B, and usually include prescription drug plan too. Some plans may also offer additional benefits like gym memberships, transportation to medical appointments, and home-delivered meals. It's recommended to use the Medicare Plan Finder for a detailed comparison of the available options.

Are people generally satisfied with their Medicare Advantage?

A: Studies show that over half of all Medicare beneficiaries are satisfied with their Medicare Advantage Plans due to the additional benefits and structure these plans provide. However, satisfaction levels can vary based on a person's specific health insurance needs and experiences.

Are there any cons of Medicare Advantage?

 Some subscribers have reported downsides to these plans. One of the cons of Medicare Advantage is the limited network of doctors and healthcare providers who accept these insurance plans. Also, these plans often have higher out-of-pocket costs than traditional Medicare and may require referrals for specialist visits.

What are the pros of Medicare Advantage?

 Medicare Advantage Plans are generally praised for their included prescription drug coverage, additional healthcare services not covered by traditional Medicare, and the maximum limit on out-of-pocket costs subscribers have to pay each year.

Can I switch from traditional Medicare to Advantage?

Yes, you can switch your plan during the Medicare Open Enrollment period, which runs from October 15 to December 7 every year. To help with the transition, you can reach out to your State Health Insurance Assistance Program (SHIP) for free, objective assistance.

Is Medicare Part B included in a Medicare Advantage Plan?

 Yes, Medicare Advantage (Medicare Part C) includes everything traditional Medicare covers, including both Medicare Part A and Medicare Part B benefits.

If I have a Medicare Advantage Plan, can I have a Medigap Plan too?

 No, if you have a Medicare Advantage Plan, you are not eligible to purchase a Medigap Plan. Medigap Plans are designed to supplement traditional Medicare, not Medicare Advantage Plans.

How do I enroll in a Medicare Advantage Plan?

You can enroll in a Medicare Advantage Plan during your Initial Enrollment Period when you first get Medicare, or during the Annual Medicare Open Enrollment period from October 15 to December 7. You can use the Medicare Plan Finder to compare and choose a plan that fits your needs.

Do all doctors accept Medicare Advantage Plans?

 Not all doctors and healthcare providers accept Medicare Advantage. Before subscribing to a plan, it's important to check whether your preferred healthcare providers are part of the plan's network.

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Brexden Insurance Agency Inc

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Email: brexdeninsuranceagency@gmail.com

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