Medicare Advantage Disadvantages

What are some disadvantages of Medicare Advantage?

Well, there are doctor networks that you need to be aware of. There are PPO plans and HMO plans. And I’m not going to dive into all the different types, but some of them require you to go to certain networks like an HMO. And then there are plans like PPO plans, which you can go in and out of network, but you may pay more if you go out of network.

So just know that there are some doctor networks we need to be aware of. The good thing is Medicare Advantage plans and their daughter networks are just getting stronger and stronger. So particularly in the Savannah market, you know, we don’t have a problem really finding doctors that are that are in and same with Augusta. Charleston networks are getting stronger and stronger with claims and authorizations.

While that option one Medicare supplement, they don’t really run into any problems with claims or authorizations. Medicare Advantage plans sometimes because it’s an insurance company that’s administering your health care. Now, if you needed a surgery, well, this insurance company might come back and say, “Hold on, doc, before you try to perform the surgery, have we tried a medication or have we tried some physical therapy?”

You know, they don’t want to spend their money on these things, so there could be some pushback there. We don’t see it a lot. We try to give you kind of worst-case scenarios. On some things, referrals could be needed. For instance, situations with the Medicare Advantage plan. There are specific service areas for Medicare Advantage plans you won’t see, typically a federal Medicare managed plan.

They are kind of specific to regions. And if you had an emergency while you were traveling, you know, across the country, you could go to the hospital, you could do whatever you need to do. But if you were traveling and wanted to go see a doctor while you’re out of town, and I don’t know who does that, you know, unless it’s an emergency.

But you may pay more because you’re outside of the service area.