How to Find the Perfect Plan
Medicare Advantage (Part C) plans can offer great benefits, but some are notorious for high costs, limited coverage and poor customer service. Choosing the wrong plan can leave you with unexpected expenses and restricted access to care. In this article, we’ll compare some of the worst aspects of Medicare Advantage plans, highlight key issues and help you avoid common pitfalls.
Key Factors That Make a Medicare Advantage Plan Bad
Not all Medicare Advantage plans are created equal. Here are some red flags to watch for:
- High out-of-pocket costs. Some plans advertise low premiums but make up for it with high deductibles, copays and coinsurance.
- Limited provider networks. Some plans restrict you to a narrow network of doctors and hospitals, which can be a major issue if you need specialized care.
- Poor coverage for out-of-network care. Many Medicare Advantage plans have minimal or no coverage for out-of-network providers, leaving you to pay the full cost.
- High prescription drug costs. Some plans have unfavorable drug formularies, meaning your medications may not be covered or may require a high copay.
- Frequent denials of care. Some plans have a reputation for denying coverage for medically necessary treatments and procedures.
- Bad customer service. Poor communication, slow claims processing and unhelpful representatives can make dealing with your plan more difficult than it needs to be.
Comparing Some of the Worst Medicare Advantage Plans
It’s essential that you choose a plan that suits your specific needs. Therefore, in order to pick the right one for you, it’s important to know which ones not to opt for. These are some of the worst-rated Medicare Advantage providers in terms of cost, coverage and customer satisfaction:
1. WellCare Medicare Advantage
- Pros: Low premiums in some areas.
- Cons: High out-of-pocket costs, frequent claim denials and poor customer service ratings.
- Key complaint: Many users report that WellCare denies necessary treatments and has long wait times for approvals.
2. Cigna Medicare Advantage
- Pros: Some plans offer good preventive care benefits.
- Cons: Limited provider network, inconsistent customer service and high prescription drug costs.
- Key complaint: Many enrollees struggle to find in-network specialists, leading to high out-of-pocket expenses for necessary treatments.
3. Humana Medicare Advantage
- Pros: Some plans offer wellness benefits.
- Cons: Costly copays, strict prior authorization requirements and poor customer service.
- Key complaint: Members report difficulty getting approval for necessary procedures, leading to treatment delays.
4. Aetna Medicare Advantage
- Pros: Competitive premiums.
- Cons: High deductibles, expensive drug coverage and network restrictions.
- Key complaint: Users often find that their medications are not covered or are subject to unexpected price increases.
5. UnitedHealthcare Medicare Advantage
- Pros: Large provider network.
- Cons: High costs for specialists, prior authorization challenges and inconsistent coverage.
- Key complaint: Many enrollees report difficulties in getting specialist care covered, leading to high out-of-pocket expenses.
What to Avoid When Choosing a Medicare Advantage Plan
To ensure you don’t end up with a bad plan, consider these tips:
1. Check the Provider Network
Make sure your preferred doctors and hospitals are in-network. Some plans have restrictive networks that force you to change doctors or travel far for care.
2. Compare Out-of-Pocket Costs
Look beyond just the monthly premium. Consider the deductible, copays, coinsurance and maximum out-of-pocket limits.
3. Review Prescription Drug Coverage
If you take medications regularly, check the plan’s formulary to ensure your prescriptions are covered at a reasonable cost.
4. Read Customer Reviews
Check consumer reviews and ratings from sources like Medicare.gov, the Better Business Bureau and consumer advocacy groups to see what real users are saying.
5. Avoid Plans with Excessive Prior Authorization Requirements
If a plan frequently requires prior authorization for treatments and medications, it may delay or deny care, leading to frustration and unexpected costs.
6. Consider Star Ratings
Medicare assigns star ratings to plans based on quality and customer satisfaction. Avoid plans with ratings below three stars, as they tend to have more issues with coverage and service.
Final Notes
While some Medicare Advantage plans offer valuable benefits, others come with excessive costs, poor coverage and frustrating customer service. By carefully comparing options, reading reviews and considering factors like provider networks and out-of-pocket costs, you can avoid the worst Medicare Advantage plans and find one that meets your healthcare needs.