The Disadvantages of Medicare Part C

Medicare is a federally-administered health care program for the elderly and disabled of the United States. Medicare enrollees have a few options for how they receive their health care benefits. They can either receive their benefits directly from the federal government, or they can receive their benefits through Medicare private health plans under Medicare Part C, known better as Medicare Advantage plans. Medicare Advantage plans are becoming increasingly popular; however, they aren't perfect for everyone. Here are some of the disadvantages of Medicare Advantage.

Higher Costs

• While Medicare Advantage (MA) often promises lower co-payments, the costs add up a lot quicker than they do with traditional Medicare. Most MA plans have higher deductibles and higher premiums than traditional Medicare. MA beneficiaries may also find themselves paying more out of pocket due to MA's plans further restrictions. Some benefits that traditional Medicare pays in full, for example, MA plans may charge a copayment for.

Plans Change Frequently

• MA plans are private companies. This means they can go out of business, merge with another company or they can decide to cease coverage at any time. Furthermore, each year, benefit packages change, including prices and covered services. In order to ensure they get the care they need, MA enrollees must be diligent consumers.

Limited to a Network

• The majority of MA plans are HMOs or other types of private health care plans that work with a network of providers. Patients must see doctors or providers within this network. This poses many problems for some MA enrollees. First, it may keep them from seeing the doctor they want to see, whether it is a doctor they like or the doctor that will provide the best service. Second, it often causes difficulty when requiring emergency or urgent care outside of the network area. While MA plans are required to cover all emergency and urgent care visits regardless of whether they are in network or not, Medicare Rights Center reports that they receive many calls to their Medicare advice hotline from Medicare-enrollees whose emergency or urgent care bills are not being paid for by their MA plans.

  Furthermore, doctors often leave HMO or other private health care plans' networks. If a doctor leaves a network suddenly, the patient no longer can see the doctor. This can be harmful to a patient who has on-going treatments.

Barriers to Coverage

• Private health plans are sometimes fraught with rules and regulations that can come between consumers and the health care they need. Oftentimes, patients require the plan's permission in the form of prior authorization before they can receive certain treatments or medications. When a prior authorization is denied, the patient must undergo a lengthy appeals process. Traditional Medicare does not require prior authorization.

Inability to Buy a Medigap

• Medigap plans are supplemental insurance plans that help pay for some of the extraneous costs associated with Medicare. Those who go visit the doctor frequently or have many visits to the hospital benefit from this supplemental insurance policy because it pays for many of the coinsurances and deductibles. Medigaps, however, work only with traditional Medicare.