Retirees have benefited a lot from the Medicare program since its inception in 1965. With the 2025 open enrollment period for the program approaching, some may be thinking about switching to a Medicare Advantage plan.
While these plans may appeal to the masses with their low premiums, they aren’t the best choice for every individual. Below, we discuss things retirees need to consider before moving to Medicare Advantage, as well as why they may prefer to remain covered under Original Medicare.
So, what should retirees know about Medicare Advantage?
For starters, these plans have limited provider networks as they operate within narrower networks which may exclude an individual’s preferred specialist or physician. This differs from original Medicare, which provides extensive coverage at almost every clinic and hospital in the country.
Not having access to some doctors is a big issue, particularly for retirees who require access to specific specialists or have formed long-term relationships with particular physicians.
In areas that are less populated or rural, beneficiaries of Medicare Advantage may find it even harder to find providers within their network given the already limited medical options. This is to mean that individuals who choose to enroll in Medicare Advantage would have access to less coverage in exchange for saving some money.
Additionally, prior authorization is required for many diagnostic tests, procedures, and treatments under Medicare Advantage. This means that beneficiaries are required to obtain approval from their insurer prior to receiving a range of medical services.
While prior authorization does control costs, it can lead to complications and delays, especially in dire situations. Under Original Medicare, individuals can efficiently access different medical services, a plus for retirees who know they can receive timely care with zero delay.
Furthermore, additional costs like coinsurance and copayments are associated with Medicare Advantage plans, a downside for retirees who require specialized or frequent medical care. By contrast, original Medicare provides a more reliable cost structure, which allows retirees to plan their medical budgets over the long term.
Retirees who’d still like to enroll for Medicare Advantage need to consider their current medical priorities, needs and tolerance for financial risk. It is important to keep in mind that while Medicare Advantage plans may be suitable for individuals with tight budgets and generally good health, those who value flexibility when it comes to accessing care or with more complicated medical needs may derive more benefit from original Medicare.
It is also helpful to reach out directly to MA providers like Astiva Health so that one can ascertain beforehand whether their offerings will suit your needs before you make a decision to enroll for the program.
NOTE TO INVESTORS: The latest news and updates relating to Astiva Health are available in the company’s newsroom at https://ibn.fm/Astiva
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