Medicare Advantage plan pros and cons

Read PracticeLink articles from Michele Gutermuth.
Michele Gutermuth

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Medicare Advantage plans continue to be a topic of discussion, as this is a popular private insurance alternative to traditional Medicare. There are pros and cons to you as a physician and to your patients when choosing to participate in these plans.

Most plans have long-term savings and flexibility, and some think they offer better care, but plans can come with additional costs, offer fewer choices when it comes to providers, and have some other challenges.

Some plans offer hospitalization, hospice care, doctor’s visits, drug coverage, preventative care, dental, vision, and hearing coverage. Some common plans include health maintenance organizations (HMOs), preferred provider organizations (PPOs), private fee-for-service plans and special needs plans.

This offers your patients convenient coverage options and personalized plans specific for their needs and potential cost savings, allowing you to coordinate care with multiple physicians for your patient. In general, it may help with unnecessary multiplication of medical tests and provide better care for your patients.

Some of the disadvantages for your patients might be the limited number of providers, extra expenses they may not be used to paying, and sometimes the plans can get complicated.

Medicare Advantage plans are a growing field. Enrollment has doubled over the past decade, and growth appears to be continuing. For example, UnitedHealthcare plans to expand its Medicare Advantage plans to include another 3.2 million people across 300 counties.

Each physician may have their own reasons for deciding whether to join a Medicare Advantage plan network. If you are a new doctor trying to build a practice, you might like a Medicare Advantage plan’s structure, allowing you to join a practice that’s already set up. Or you might feel you have more flexibility under the traditional Medicare plans, where you are not bound to network rules.

I have also heard some physicians do not like them because they say the payments come slower than from the traditional Medicare plan. Also, because many Medicare Advantage plans offer no premiums and more out of pocket costs, physicians are sometimes left collecting for services they did not need to collect under traditional Medicare.

In the end, you should think about the best situation for you, your practice and your short- and long-term plans when considering Medicare vs. Medicare Advantage plans.  

Read PracticeLink articles from Michele Gutermuth.

Michele Gutermuth

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