The Disadvantages of Medicare Advantage Plans
Medicare is federal health insurance, available to seniors and disabled persons in the United States. Medicare Advantage (MA) Plans are private insurance companies that provide Medicare services and some additional benefits such as prescription drugs, dental or vision, or home care. Varieties of MA plans are Health Management Organizations (HMO), Preferred Provider Organizations (PPO), Private Fee for Service Plans (PFFS), Special Needs Plans and Medicare Medical Savings Accounts.
HMO Disadvantages
Beneficiaries of HMO plans are restricted to doctors, specialists and hospitals in the plan network, which are assigned to the policy holder. According to Physician Assistant Mitchell Claire, of Nueva Clinica California, the HMO pays the primary care physician every month whether the policy holder is seen by him or not. It may be difficult to get appointments with some providers. Lengthy approval processes are discouraging to many participating doctors and patients. If a physician or specialist drops out of the HMO network, patients must find another provider and transfer records. Continuity of care is compromised.
PPO Disadvantages
PPO plans also have a network of physicians, specialists and hospitals, but patients have the freedom to choose out-of-network providers. Coverage is less and out-of-pocket costs are higher for those providers who are outside the PPO plan's main network, however.
SNP Disadvantages
Special Needs Plans pertain only to certain low-income populations, those with severe chronic conditions or residents of nursing homes. SNP coverage is not available in all areas.
PFFS Disadvantages
Private Fee for Service plans decide how much patients pay for care and services, and fees can exceed standard Medicare co-pays. Any doctor that accepts the plan can be seen, but prescription drug coverage may not be part of a PFFS Plan.
MMSA Disadvantages
Medical Savings Accounts combine high-deductible private health insurance with a tax-advantaged savings account. Patients pay for routine care out of the savings account until deductibles are met, when insurance takes over. The annual deductible may reach $6,000.
General Drawbacks
Enrollment in Medicare Advantage Plans is limited to an annual period from mid-November to the end of each year, except in special cases, such as moving into a nursing home. Changing plans can be done during the open enrollment period. If the patient changes her mind at a later date, however, the previous coverage may not be restored once a plan is left . People with End-Stage Renal Disease are not eligible for Medicare Advantage Plans; however, they cannot be kicked off an MA plan because they develop that condition.
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