What is the biggest disadvantage of Medicare Advantage?
Answered by 68 licensed agents
Medicare Advantage plans has specific doctors and hospitals in their network, so these plans are network based.
Prior Authorizations are needed for some services, which can cause some delay in necessary care.
It's important to check each year to make sure your doctor is still in the network, as this can change from year to year.
Answered by Linda Bolan on March 12, 2025
Agent Licensed in IN
Answered by Larry Dalton on March 26, 2025
Broker Licensed in OK & TX
Answered by Gary Church on June 20, 2025
Broker Licensed in Ca, AZ, NV & TX
Answered by Brian Moore on March 26, 2025
Broker Licensed in OH
Answered by Melonie Wood on March 30, 2025
Agent Licensed in FL & AL
Plans are insured or covered by a Medicare Advantage (HMO, PPO and PFFS) organization with a Medicare contract and/or a Medicare-approved Part D sponsor. Enrollment in the plan depends on the plan’s contract renewal with Medicare. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
Answered by Andrew Zurbuch, MBA on June 13, 2025
Broker Licensed in IN, FL, KY, MO, OH & TN
Answered by Nikki Rowland on April 2, 2025
Broker Licensed in SC & NC
Answered by Voss Speros on June 4, 2025
Broker Licensed in AZ, CA, ID & 7 other states
Answered by Brian Krantz on March 25, 2025
Broker Licensed in NY, AK, AL & 48 other states
Answered by Robert Pennington on March 25, 2025
Broker Licensed in NC, GA, SC & VA
Due to network limitations, proper care may not be available. Many more disadvantages that a supplement plan would cover.
Answered by James Carlson on March 27, 2025
Agent Licensed in MN
Another complaint, not as often, but is financially significant, is the senior was unaware that in most cases, after the senior has been enrolled in the MA/MAPD for more than 12 consecutive months, they may not health qualify (Cancer, Stroke, Heart Attack, Dementia, COPD, etc) to go back to a Medicare Supplement and may be limited to MA/MAPD coverage for several years.
Answered by Christopher Boyd on March 4, 2025
Agent Licensed in IN, KY, MI, OH, PA & TN
Answered by Michael Andrews on March 26, 2025
Broker Licensed in CT
Sometimes, plans may require that you get a referral or prior authorization. For example, the HMO plans may require that you see the primary care physician who is the gatekeeper to get a referral to see a specialist.
Medicare Advantage plans are typically restricted to the local area. If you travel, it is important to consider that you may not be able to see a doctor or specialist unless it is an emergency situation.
Medicare Advantage costs can be unpredictable. You will want to check all of the details of the plan to include copays, coinsurance and deductibles as well as the maximum out of pocket amount for the calendar year. Medicare beneficiaries who choose a Medicare Advantage plan need to consider utilization which factors into the unpredictability of costs.
Answered by Steven Whetstine on June 21, 2025
Agent Licensed in AZ, ID, IN & 6 other states
Max out of pockets can be high depending on program especially while out of network.
Answered by Christopher Palazzini on March 25, 2025
Broker Licensed in FL, CA, GA & 6 other states
Answered by Bill Green on March 26, 2025
Broker Licensed in FL, AL, AZ & 19 other states
Answered by Michael Ryan on March 25, 2025
Broker Licensed in CA, AZ, CO & 7 other states
Answered by Bryan Smith on March 10, 2025
Broker Licensed in UT, AL, AR & 35 other states
Answered by Vincent Esposito on March 26, 2025
Broker Licensed in NY, FL & NJ
Answered by Don Hudson on March 30, 2025
Broker Licensed in FL
Unlike Original Medicare, many Medicare Advantage plans have restrictive networks. You may not be able to see your preferred doctors or go to certain hospitals unless they’re in-network.
Prior Authorization Requirements
Many Advantage plans require prior approval for services or procedures, which can delay care and add extra administrative hassle.
Unexpected Out-of-Pocket Costs
While premiums may be lower, Medicare Advantage plans often have higher copays and coinsurance for certain services, and the cost can add up—especially if you have chronic conditions.
Answered by Edward Givens on March 25, 2025
Broker Licensed in AZ, CA, CO & 13 other states
Answered by Karen Boudreaux on March 13, 2025
Agent Licensed in TX, AZ, CA & 5 other states
Answered by Lance Stanley on March 27, 2025
Broker Licensed in FL, AL, GA, MS & TX
It’s true that you have more “freedom” with a Medicare Supplement (Medigap) policy, but it will cost you. For some, that additional expense can be cumbersome.
Medicare Advantage can be a very good fit for some people. It just depends on everyone’s unique situation.
Again, that’s why it’s important to work with a professional, someone who can explain your options in-depth and discuss the pros and cons of each.
Answered by Samantha Jellison on March 6, 2025
Broker Licensed in NC, FL & SC
Answered by Shane Bullock on March 11, 2025
Broker Licensed in UT, AZ, FL & 9 other states
Answered by Phillip Lovelady on March 25, 2025
Agent Licensed in TX
Answered by Shane and Tammy Carpenter on March 23, 2025
Broker Licensed in OK, AR, FL & 5 other states
Answered by Sandra Bailey on May 31, 2025
Broker Licensed in TN, AL, AR & 13 other states
Answered by Justin Scheiner on April 7, 2025
Agent Licensed in FL, CT, GA, NJ, NY & SC
Answered by William Lewkowski on March 25, 2025
Broker Licensed in TN, AL, AR & 30 other states
Answered by Kim Cotten on May 19, 2025
Broker Licensed in FL, AL, AR & 40 other states
You'll be restricted to the plan's network of doctors, which can result in substantial costs for out-of-network care and difficulty accessing specialists. Although monthly premiums are often low or nonexistent, you'll face a hefty annual maximum out-of-pocket—potentially between $4,000 and $10,000.
The biggest disadvantage in our opinion, is you must expect delays. Specialist referrals and network limitations can hinder timely access to necessary care.
Answered by Jose Solis-Flores on March 26, 2025
Agent Licensed in OH, CA, IN & 5 other states
Answered by Bob Thompson on March 25, 2025
Agent Licensed in IA
Answered by Steven Bleicher on May 29, 2025
Broker Licensed in AZ
Answered by Timothy Brown on April 28, 2025
Broker Licensed in PA, CT, DE & 15 other states
Medicare Advantage plans operate in specific networks. Depending on which plan you are enrolled in, you could have one of the following networks:
1) Health Maintenance Organization (HMO)
2) Preferred Provider Organization (PPO)
3) Private Fee-for-Service (PFFS)
Answered by Diana Garner on May 7, 2025
Broker Licensed in KY, FL, IN, OH & TN
Answered by Gregg Matheny on March 25, 2025
Agent Licensed in AZ & UT
Answered by Michael Pyers on March 26, 2025
Broker Licensed in OH & MI
Answered by Steve Houchens on April 2, 2025
Agent Licensed in KY & TN
Most Carriers include the Majority of Major Hospitals in the plan network. There are some Carriers that can exclude certain Hospitals and Doctors in Network.
Co-pays also - Review your Summary of Benefits to understand the outline of Co-pays.
Answered by Leslie Helene Sussman on March 31, 2025
Broker Licensed in NJ, FL & PA
Fortunately, the upside is that good health care is being provided through Medicare Advantage Plans and clients need this option very much.
Answered by John L Herman Jr on March 29, 2025
Broker Licensed in MD, DE & PA
Answered by Joseph Peck on July 1, 2025
Agent Licensed in MI, AL, CO, KS & TN
Cleo Martin
803-730-8368
Answered by Cleo Martin on April 4, 2025
Agent Licensed in SC, AL, FL & GA, MI, NC & TX
Answered by Sean Davis on March 26, 2025
Broker Licensed in NY, LA, MD & 6 other states
Answered by Julie Joyce on March 25, 2025
Agent Licensed in PA, CT, DE & 9 other states
Answered by Ami Fouts on March 27, 2025
Broker Licensed in NH & ME
Answered by George Kolitsas on March 25, 2025
Broker Licensed in CT
Answered by Helena Foutz, RSSA on March 4, 2025
Broker Licensed in CA, AK, AR & 12 other states
Answered by Ryan Raphael on March 5, 2025
Broker Licensed in MO, AZ, GA, IL & TN
Answered by Robert Helmkamp II on May 12, 2025
Broker Licensed in AZ
Answered by Christie Bondos on May 26, 2025
Broker Licensed in CT
- Medicare Advantage offers extra benefits, but out-of-network care may be limited or costly.
- Other disadvantages include difficulty switching out of the plans later, restrictions on care access, and limitations on extra benefits.
- Geographical restrictions also mean you cannot access care if you travel out of state unless you have an emergency or need dialysis.
- Medicare Advantage plans can change benefits annually or drop providers mid-year.
- MA plans could be a fit for people on a tight budget or who would qualify for a special needs plan.
Answered by Fred Manas on May 5, 2025
Agent Licensed in NY, CT, DC & 7 other states
Answered by Vachik Chakhbazian on July 1, 2025
Agent Licensed in CA, AL, AR & 22 other states
1. Most Don include prescription drug coverage
2. Dentist Don accept their dental coverage
3. If you travel out of network, they'll either be slow to pay or refuse to pay.
4. Very restrictive on who you can see.
Answered by Suzanne Lamperti on June 8, 2025
Broker Licensed in MD
Let’s explore plan options suitable to your individual needs. Give me a call or message with a good time to talk. And thanks for asking.
Answered by Linda Davies on June 15, 2025
Broker Licensed in IL
Answered by Robert Remin on May 19, 2025
Agent Licensed in NY, CT, FL & NJ
Answered by Aisha Saleem on March 13, 2025
Agent Licensed in MD & FL
In that case they can also choose a PPO plan but they will pay a higher cost for the copays for the doctors not being in the network.
So the other options is to go with a Supplement Plans, but not all qualify.
Answered by Michael Kim on March 25, 2025
Agent Licensed in NV, AR, AZ & 18 other states
Answered by Sonya Chandler on May 21, 2025
Agent Licensed in NY, AZ, FL & 5 other states
Answered by Lesley Burns on April 21, 2025
Broker Licensed in AR, MI, MO, NM & TX
Answered by Maci Mishler on June 9, 2025
Broker Licensed in NE, AR, KS & MO, ND, OK & TX
Advantage is good while you are healthy and not utilizing may services.
Answered by Edward Cavelli on March 26, 2025
Agent Licensed in Pa, FL, OH, TX, VA & WV
Answered by Toni Johnson on May 19, 2025
Agent Licensed in FL, IN, MO & 5 other states
The trade off is that Medicare advantages plans often provide predictable cost sharing and many other benefits that may fit your healthcare needs.
Answered by Justin Hundley on June 16, 2025
Broker Licensed in WV, FL, KY, OH & VA
Answered by Soledad Ramirez on March 12, 2025
Broker Licensed in CA, AZ, NV & WA
Why?
1. Limited Network of Doctors & Hospitals
Unlike Original Medicare, seeing any doctor or specialist that accepts Medicare nationwide, Medicare Advantage plans (HMOs and PPOs) want you to use a network of approved providers. Some hospital networks do not accept them at all; Scripps Hospital in San Diego and the Mayo Clinic are just two examples of networks that do not accept Advantage plans.
If you can go out-of-network, you pay more. Some services may not be covered at all. (HMOs).
2. Potential for Higher Out-of-Pocket Costs
While MA plans often have lower monthly premiums, they can come with higher copays or coinsurance for certain services, especially: Out-of-pocket maximums.Hospital stays, specialist visits, and durable medical equipment all cost more and have limits
3. If you have chronic conditions or need a lot of care, these costs can add up quickly, possibly making the plan more expensive than Original Medicare + a Medigap plan.
4. Prior Authorization Requirements
Many MA plans require prior authorization for services like MRIs, rehab, home health care, and even some medications. This can delay care and cause stress if approvals are slow or denied.
Answered by Tracy Brown on April 14, 2025
Broker Licensed in CA, AL, AR & 32 other states
Answered by Chris Bumgardner on March 21, 2025
Broker Licensed in FL, CO, IL & TN
Answered by Kilolo Thomas on May 19, 2025
Agent Licensed in NJ, MS, NY, PA, SC & TX
Tags: Medicare Advantage
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