Medicare Advantage, also referred to as Medicare Part C, plans may sound enticing. As one plan, it combines Medicare Parts A and B benefits and may cover prescription (D) and other benefits. Many offer $0 premiums, but the devil is in the details. You will find that most have unexpected out-of-pocket expenses when you get sick and only want you as a customer when you’re healthy.

Coverage Choices When You Qualify for Medicare

When choosing medical coverage as a senior citizen 65 years old and over, you can make one of three choices:

KEY TAKEAWAYS

A Medicare Advantage (MA) plan, known as Medicare Part C, provides all of Part A and B benefits and sometimes Part D (prescription) and other benefits.
All Medicare Advantage providers must accept Medicare-eligible enrollees.
Sick participants may find that medical care costs skyrocket under a Medicare Advantage plan due to co-pays and out-of-pocket expenses.
Medicare Advantage customers can switch back to Traditional Medicare once per year during the annual enrollment period.
Prospective Medicare Advantage customers benefit from researching plans, reviewing co-pays, out-of-pocket costs, and eligible providers.

Most Comprehensive Coverage

The most comprehensive coverage, which will likely result in the fewest unexpected out-of-pocket expenses, is a traditional Medicare plan paired with a Medigap policy. Medigap policies vary, and the most comprehensive coverage is offered through Medigap Type F. With Medigap Type F, all co-pays and deductibles are covered, and you even get some coverage when you travel outside the country. With this combination, you can go to any doctor who accepts Medicare. Be aware that with traditional Medicare and Medigap, you will also need part D prescription drug coverage.

The Devil Is in the Details

Medicare Advantage plans do not offer this level of choice. Most plans require you to go to their network of doctors and health providers. Since Medicare Advantage plans can’t cherry-pick their customers (they must accept any Medicare-eligible enrollee), they discourage people who are sick by the way they structure their co-pays and deductibles.

 

Author Wendell Potter explains how many Medicare Advantage enrollees don’t find out about the limitations of their Medicare Advantage plans until they get sick:

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