Medicare Advantage plans are growing in popularity. The U.S. Congressional Budget Office projects that the share of all Medicare beneficiaries enrolled in Medicare Advantage plans will rise from 42% (2021) to 51% by 2030.
One can certainly understand the allure: Medicare Advantage plans, sometimes called Medicare Part C, are health care plans offered by private companies. They typically offer lower premiums than traditional Medicare and are known for providing coverage for medical services that the government-run program doesn’t such as dental and vision.
Thinking of Getting a Medicare Advantage Plan? Read This
Money expert Clark Howard says he gets plenty of advertisements about Medicare Advantage plans in the mail. He says, for the most part, he’s not a fan.
“Medicare Advantage plans are generally a disadvantage plan for you,” Clark says.
If you’re thinking about signing up for a Medicare Advantage plan because of advertisements touting how great they are for everyone, Clark wants you to think again.
In this article, we’ll get Clark’s recommendation for the only reason you should get a Medicare Advantage plan and what you should get in all other cases.
Why Clark Doesn’t Like Medicare Advantage Plans
Clark says he doesn’t like Medicare Advantage plans — which he calls “disadvantage plans” — because of their profit-driven motives that allow them to routinely deny care to enrollees.
He cites a recent report from the Office of the Inspector General, U.S. Department of Health and Human Services, which found that private health care companies providing Medicare Advantage plans sometimes delay or deny beneficiaries’ access to services even though the requests meet Medicare coverage rules. The report says some companies also denied payments to providers for services that met both Medicare coverage rules as well as the Medicare Advantage organizations’ (MAOs’) own billing policies.
The report further found: “To reduce their costs, MAOs may have an incentive to deny more expensive services, such as inpatient rehabilitation facility stays, and/or require that beneficiaries receive less expensive alternatives.”
“The insurance companies are making a ton of money on these plans. And how are they making a ton? From denial of care. That’s the whole game,” Clark says.
“As somebody gets older, we get more things wrong with us, we spend more time dealing with conditions, chronic and otherwise. And as an insurer, if you can delay, delay, delay, deny, you’re not spending that money,” he adds.
But Clark says there is one situation in which you should consider a Medicare Advantage plan.
Here’s the Only Reason To Get a Medicare Advantage Plan
“The people who should go into a Medicare Advantage plan are those who cannot afford to pay the premiums because you’re on a tight, tight budget and you have to accept the choice of less choice in your health care,” Clark says.
“Denial of care is part of what you get,” he adds.
Here’s a Clark-Approved Medicare Plan Formula
Clark says if your financial situation is such that you can handle paying for traditional Medicare, that’s the way to go.
“If you can afford the premiums for Part B and Part D and to buy your Medigap, and you want true comprehensive, real medical coverage as you age through your 60s, 70s, 80 and beyond, go into traditional Medicare,” he says.
Medigap coverage, which is sold by private companies, is medical insurance that fills in the gaps of traditional Medicare by helping to pay out-of-pocket costs.
Clark says if you have no other option, Medicare Advantage plans will have to do, but if you can afford traditional Medicare, you should take advantage of it.