What is Medicare Advantage?
Medicare Advantage is an insurance plan available through Medicare Part B. Medicare Part B is the insurance that covers the cost of physician services. The traditional Medicare Part B insurance covers 80% of the physician’s fee after an annual deductible has been met. Medicare Advantage is a program designed to cut costs of medical care. It covers a greater part of the physician’s fee and also covers some accessory services such as eye glasses. However, it restricts access to some services compared with the traditional Medicare Part B insurance.
Why might someone choose Medicare Advantage?
The main reason for choosing Medicare Advantage is to reduce the out-of-pocket costs of health care. The benefits are obvious. However, the costs in terms of limited access to treatment must be carefully considered.
What are the limitations of Medicare Advantage?
Medicare Advantage attempts to reduce the cost of medical care. They do this by limiting access to expensive treatments. For example, they require that physicians use the least expensive drug (called Avastin) for retinal disorders such as diabetic retinopathy, macular degeneration and retinal vein occlusion. Avastin must be compounded by a pharmacy after it has been manufactured because it is not FDA-approved for use in the eye. Therefore, there are increased risks including infection and floaters from silicone oil droplets. Other, more expensive drugs (called Lucentis) reduce the risk of stroke and heart attack after injection into the eye, especially in people who require repeated injections (such as in diabetic retinopathy).
Patients who are on the traditional Medicare Part B plan currently have access to the newest drug for macular degeneration and diabetic retinopathy, called Vabysmo. As of the time of this article, Medicare Advantage plans do not allow doctors to use this drug even though it offers the potential for fewer injections compared with other drugs such as Avastin. As with most things in life, you get what you pay for. If you opt to save money by signing up for Medicare Advantage, you can expect less in terms of medical care. Medicare Advantage plans may turn out to put you at a disadvantage.
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