3 Biggest Gaps in Medicare Advantage Plans
Medicare Advantage plans offer great value, but they have limitations. Learn the three biggest coverage gaps and how to fill them.
Understanding Medicare Advantage Limitations
Medicare Advantage plans provide excellent value with low premiums and extra benefits. However, every plan has coverage gaps that can catch you off guard.
Knowing these gaps helps you prepare and find solutions before you need them.
Gap #1: Limited Provider Networks
The Problem
Medicare Advantage plans use networks of contracted doctors and hospitals. Going outside the network can be expensive or not covered at all.
Real-World Impact
You might face these situations:
- Your specialist isn't in the new plan's network
- Emergency care while traveling leads to surprise bills
- The best hospital for your condition isn't covered
How to Fill This Gap
Always verify your doctors are in-network before enrolling. Consider travel insurance if you spend time outside your plan's coverage area.
Gap #2: Coverage Outside Your Service Area
The Problem
Most Medicare Advantage plans only work in specific counties or regions. Travel or temporary relocation can leave you with limited coverage.
What's Covered vs. What's Not
- Covered: Emergency and urgent care anywhere in the US
- Not covered: Routine care, specialist visits, planned procedures outside your area
Solutions
If you travel frequently or live in multiple states, consider Original Medicare with a supplement instead of Medicare Advantage.
Gap #3: Long-Term Care Coverage
The Problem
Medicare Advantage plans cover short-term skilled nursing care but don't cover long-term custodial care that most seniors eventually need.
The Numbers
About 70% of seniors will need some form of long-term care. Average costs:
- Home care: $5,000+ per month
- Assisted living: $4,500+ per month
- Nursing home: $8,000+ per month
Filling the Gap
Consider long-term care insurance while you're healthy. Hybrid life insurance policies with LTC benefits are also popular options.
How to Prepare for These Gaps
Network Gap Solutions
- Choose plans with larger networks
- Verify your doctors accept the plan each year
- Have backup providers identified
Geographic Gap Solutions
- Purchase travel health insurance
- Consider Original Medicare if you travel extensively
- Know emergency procedures in other states
Long-Term Care Gap Solutions
- Purchase long-term care insurance early
- Consider hybrid policies that combine life insurance and LTC coverage
- Build savings specifically for care costs
Should You Still Choose Medicare Advantage?
These gaps don't mean Medicare Advantage is bad. For many people, the benefits outweigh the limitations.
Medicare Advantage works well if you:
- Stay primarily in your home area
- Are comfortable with network restrictions
- Want low premiums and extra benefits
- Address the gaps with separate coverage
Making an Informed Decision
Understanding these gaps helps you choose the right Medicare path. Some people prefer Original Medicare with supplements to avoid network restrictions.
Others find Medicare Advantage works well and use supplemental insurance to fill specific gaps.
The key is making an informed choice based on your lifestyle, health needs, and budget.