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November 13, 2023

Beware of these common misconceptions and stay informed during Medicare's Annual Enrollment Period.

5 Myths About Medicare Advantage Plans

Don't let misinformation misguide you! Debunking Medicare Advantage myths and clarifying the facts for informed choices.

It's likely that you've been gathering Medicare advice from various sources such as relatives, neighbors, and even strangers in the doctor's waiting room. One friend may claim to have the best and most comprehensive coverage, while another insists that their plan is the most affordable option.

While this advice is well-meaning, it's important to remember that you are the one who understands your health needs and financial situation best.

That's why the Medicare Annual Enrollment Period, which spans from October 15 to December 7, holds great significance. If you currently have a Medicare Advantage Plan (Part C) or are considering a switch from Original Medicare (Parts A and B) to a Medicare Advantage Plan, now is the ideal time to review and ensure you are content with your coverage for the upcoming year.

To assist you in this process, we have debunked some common Medicare misconceptions and myths that may have come across your path.

Myth #1: Medicare Advantage Plans Are Uniform

Contrary to popular belief, Medicare Advantage Plans exhibit significant differences. These disparities encompass aspects such as provider networks, prescription drug coverage, and premiums.

Moreover, many Medicare Advantage Plans provide additional benefits that are not covered by Original Medicare. These additional perks can include vision, hearing, and dental coverage, as well as fitness programs like SilverSneakers.

Furthermore, there has been an increase in the availability of extra features, such as transportation to doctor appointments, out-of-state provider networks, and specialized benefits for individuals with specific chronic conditions.

It is crucial to note that not all Medicare Advantage Plans offer these supplementary benefits. Therefore, if these extras are important to you, it is advisable to consider them while reviewing your coverage options.

Myth #2: If my Medicare Advantage Plan remains unchanged, my expenses will remain the same.

While it is possible for your premiums, deductibles, coinsurance, and copayments to stay consistent, there is another crucial factor to consider: your health. This is an opportune moment to evaluate your current health requirements and anticipate potential costs.

In the beginning, you might want to assess your recent claims and review any notes from your healthcare providers. Have there been any significant changes in your health or unexpected healthcare expenses in the past year? Do you require ongoing treatment, or are you at a higher risk for certain conditions?

Next, consider any potential expenses you might encounter, even if you have not required those services previously. If you currently have, or are contemplating, a Medicare Advantage Plan, it is essential to be aware of the coinsurance or copayment amounts for:

  • Visits to primary doctors
  • Visits to specialists
  • Emergency care
  • Urgent care
  • Ground ambulance services

Myth #3: My Medicare Advantage Plan will remain unchanged.

While it is possible for your Medicare Advantage Plan to stay the same, it is equally possible for it to undergo changes. These changes can include alterations to the provider network, prescription drug coverage, and costs. This encompasses premiums, deductibles, coinsurance, and copayments, which can be modified on an annual basis.

If your Medicare Advantage Plan is undergoing changes, you will receive an Annual Notice of Change (ANOC) document in September. It is vital to thoroughly review this document to comprehend any upcoming modifications, particularly if you depend on specific services or medications.

In the event that you did not receive an Annual Notice of Change document or require further information regarding any changes, we recommend reaching out to your plan for clarification.

Myth #4: I am obligated to stick with my Medicare Advantage Plan.

If you are satisfied with your current coverage and it will be available in the upcoming year, you are free to keep it. During the Annual Enrollment Period, you don't need to take any action as your Medicare Advantage Plan will automatically renew.

However, if you would like to explore other options and consider joining a different Medicare Advantage Plan or transitioning from Original Medicare to Medicare Advantage, you have the opportunity to do so during this period. You can review your options at medicare.gov/plan-compare. Typically, you can enroll in a new Medicare Advantage Plan through online platforms or by phone, using your Medicare number, which is available on your Medicare card.

If you decide to join a new Medicare Advantage Plan, your current coverage will end on December 31, and your new coverage will begin on January 1.

Additionally, during the Annual Enrollment Period, you have the flexibility to make other changes, including switching from Medicare Advantage to Original Medicare. For more information and answers to common questions about Medicare Open Enrollment, please consult the provided resources.

Myth #5: I have the ability to change Medicare Advantage Plans whenever I want.

No, you can only make changes to your Medicare Advantage Plan during specific time periods. It is essential to be aware of the following important dates:

  • October 15 to December 7: During this period, you can join, switch, or drop Medicare Advantage Plans for the upcoming year. This includes transitioning from Original Medicare to Medicare Advantage, or vice versa.
  • January 1 to March 31: If you already have a Medicare Advantage Plan, you can switch or drop your coverage; however, only one change is permitted during this time. It is possible to switch from Medicare Advantage to Original Medicare, but switching from Original Medicare to Medicare Advantage is not allowed.

Furthermore, there are certain circumstances, such as moving to a new area or experiencing other life events, which may make you eligible for special enrollment periods.

What's the next step?

It is crucial not to let inertia or fear hinder you from taking full advantage of the Open Enrollment period, which concludes on December 7. If you currently have a Medicare Advantage Plan, carefully review your Annual Notice of Change document to understand any changes for the upcoming year. If you have been considering transitioning from Original Medicare to Medicare Advantage, now is the perfect opportunity to explore your options.

For help, check out these great resources:

Bonus Myth #6:  Medicare Advantage and Medicare Supplement are not the same.

Medicare Advantage and Medicare Supplement are two distinct programs within the Medicare system, and it is essential to understand the differences between them.

Medicare Advantage, also known as Medicare Part C, is an alternative way to receive Medicare benefits, whereby private companies are contracted to provide the same coverage as Original Medicare, along with additional benefits such as dental, vision, and hearing services. Medicare Advantage differs from Original Medicare in that there is typically a provider network and coverage restrictions, limiting when and where you can receive care.

Moreover, you cannot enroll in both a Medicare Advantage plan and a Medicare Supplement plan simultaneously.

In contrast, Medicare Supplement, also known as Medigap, is a private insurance policy designed to supplement Original Medicare. These policies help cover the costs that Original Medicare does not, such as deductibles, coinsurance, and copayments. With a Medicare Supplement plan, you have more flexibility to choose healthcare providers without limitations and restrictions, and you can receive care throughout the country.

Therefore, it is important to evaluate your healthcare needs and consider both Medicare Advantage and Medicare Supplement plans to determine which program suits you best.

About the Author: David Scallion

David Scallion is well-established as the Agency Principal at Lehigh Partners. With extensive experience in the insurance industry, Scallion has gained a deep understanding of various insurance policies, particularly in the realms of healthcare and Medicare.

As an Agency Principal, Scallion plays a pivotal role in overseeing operations, managing a team of professionals, and ensuring that clients receive optimal service and tailored insurance solutions. His expertise in the field enables him to provide valuable guidance and support to both individuals and businesses seeking comprehensive insurance coverage.

Scallion's commitment to client satisfaction, coupled with his exceptional knowledge and experience, has allowed him to build a strong reputation within the insurance industry. Through his leadership at Lehigh Partners, Scallion continues to prioritize the needs of clients, offering personalized insurance strategies and ensuring their financial protection and peace of mind.

Overall, David Scallion's dedication to his craft, extensive expertise, and leadership at Lehigh Partners make him a trusted authority in the insurance industry.

To contact: Click Here

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