Why a consumer with original Medicare may be interested in a Medicare Advantage plan?
Asked by: Mr. Kameron Borer | Last update: December 7, 2025Score: 4.5/5 (68 votes)
Why would I choose Medicare Advantage over Original Medicare?
Medicare Advantage plans can also offer more benefits than Original Medicare. Most plans include dental, vision, prescription drug coverage, and more. Because private insurers like Anthem offer Medicare Advantage plans, you also have more flexibility with your plan selection.
Why do people get Medicare Advantage plans?
With a Medicare Advantage Plan, you may have coverage for things Original Medicare doesn't cover, like fitness programs (gym memberships or discounts) and some vision, hearing, and dental services (like routine checkups or cleanings).
Why are more people choosing Medicare Advantage?
People with Medicare are drawn to Medicare Advantage for the extra benefits. Medicare Advantage plans offer extra benefits, like reduced cost-sharing, dental coverage, gym memberships and debit cards for over-the-counter medical supplies that are not covered by traditional Medicare.
Why do agents push Medicare Advantage plans?
Why do brokers push Advantage plans so hard? It's money. Sorry, that's the honest truth. The commission for an Advantage plan can be roughly double that of the most popular Medicare supplement plan and it's paid all at one time.
The Difference Between Medicare and Medicare Advantage
Why is there such a push for Medicare Advantage plans?
“More seniors continue to choose Medicare Advantage because it delivers better health care at a lower cost than Fee-For-Service Medicare,” said [BMA's CEO] “However, millions of seniors could see disruptions to their Medicare Advantage coverage next year, including plan closures, higher out-of-pocket costs, and fewer ...
How do Medicare Advantage agents make money?
Carriers pay out initial commissions when an agent makes a new sale or when the beneficiary enrolls in a new, “unlike” plan (different type). Each year and beyond, carriers pay out renewal commissions to the agent if the beneficiary remains enrolled in the plan or enrolls in a new, “like” plan (same type).
Why are people leaving Medicare Advantage?
Key takeaways: People leave Medicare Advantage plans because out-of-pocket costs vary between plans, network restrictions can cause frustration, prior authorization requests can delay care, and it can be difficult to use the additional benefits they provide.
Why do doctors not like Medicare Advantage plans?
Across the country, provider grumbling about claim denials and onerous preapproval requirements by Advantage plans is crescendoing. Some hospitals and physician practices are so fed up they're refusing to accept the plans — even big ones like those offered by UnitedHealthcare and Humana.
How do insurance companies get paid for Medicare Advantage?
Medicare Advantage is funded from two main sources. The plans receive some funding through monthly plan premiums, but most of the money comes from Medicare. The private insurance companies that offer the plans receive a payment each month from Medicare.
Does everyone have to pay $170 a month for Medicare?
Most people pay no premiums for Part A. For Medicare Part B in 2025, most beneficiaries will pay $185 per month. Certain factors may require you to pay more or less than the standard Medicare Part B premium in 2025.
Why is a Medicare Supplement better than an advantage plan?
The biggest difference between Medicare Supplement Insurance, also known as Medigap, and Medicare Advantage is that with a Medigap plan, you have the freedom to see any doctor that accepts Medicare. With Medicare Advantage, you generally must get care within the plan's network of providers.
What is the biggest problem with Medicare?
The biggest challenges reported by those in Traditional Medicare and Medicare Advantage: Out-of-pocket medical costs and health services they needed but weren't covered. “The gaps in Medicare coverage can really be notable,” says Jacobson.
What is the two midnight rule for Medicare Advantage?
The two-midnight presumption directs medical reviewers to select Original Fee-for-Service Medicare Part A claims for review under a presumption that hospital stays that span two midnights after an inpatient admission are reasonable and necessary Part A payment.
Why are Medicare Advantage plans good for seniors?
While these plans are not for everyone, they do offer important benefits not available with original Medicare. The key advantages of Medicare Advantage plans boil down to the “three Cs:” cost, coverage, and convenience. Keep in mind that your decision should be based on your own unique health needs and budget.
What are the 6 things Medicare doesn't cover?
- Eye exams (for prescription eyeglasses)
- Long-term care.
- Cosmetic surgery.
- Massage therapy.
- Routine physical exams.
- Hearing aids and exams for fitting them.
Why do people choose original Medicare over Medicare Advantage?
There's no one-size-fits-all answer, but Medicare Advantage typically has lower premiums and optional coverage, while Original Medicare often gives you more choice when it comes to choosing doctors.
Do all hospitals accept Medicare Advantage plans?
While most hospitals do accept Original Medicare, there may be some that do not accept Medicare Advantage Plans. However, if you have a medical emergency while you're enrolled in a Medicare Advantage plan, you can seek care at any ER or hospital in the country.
Can I drop my Medicare Advantage plan and go back to original Medicare?
If you joined a Medicare Advantage Plan during your Initial Enrollment Period, you can change to another Medicare Advantage Plan (with or without drug coverage) or go back to Original Medicare (with or without a drug plan) within the first 3 months you have Medicare Part A & Part B.
Why are doctors dropping Medicare Advantage?
Health systems have cited delayed reimbursements, cumbersome prior authorization requirements and high rates of patient claim denials for their decisions to drop Medicare Advantage plans.
Why are seniors losing their Medicare Advantage plans?
Health systems and hospitals are also making the decision to cancel contracts due to excessive prior authorization denial rates and slow payments from insurers. Already 27 health systems have canceled their Medicare Advantage contracts this year.
Why are hospitals refusing Medicare Advantage plans?
Among the most commonly cited reasons are excessive prior authorization denial rates and slow payments from insurers. In 2023, Becker's began reporting on hospitals and health systems nationwide that dropped some or all of their Medicare Advantage contracts.
How much do Medicare agents make per policy?
The average percentage insurers pay to agents is a 22% commission for first-time enrollees. The commission percentage is then reduced to about 10% of the plan's premium for renewals. Commission percentages vary by insurer, the type of Medigap plan sold, and the state in which the agent sells the plan.