What is the biggest disadvantage of Medicare Advantage?

Question

Linda Bolan · Accepted Answer

Medicare Advantage plans do have some great benefits, but some things to keep in mind are:  

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.

Larry Dalton · Answer

Your coverage is limited to PPO and HMO networks, and roughly 70% of major health issues will require approval before procedures can be conducted. You're required to have a primary physician who will perform and conduct your healthcare services.

Answered by Larry Dalton on March 26, 2025

Broker Licensed in OK & TX

Answered by Larry Dalton Medicare Insurance Agent

Gary Church · Answer

The disadvantages of Medicare Advantage plans include managing your healthcare. You must stay in-network and get referrals. The plans are not portable, meaning if you move outside your service area, you have to find a new plan.

Answered by Gary Church on June 20, 2025

Broker Licensed in Ca, AZ, NV & TX

Answered by Gary Church Medicare Insurance Agent

Brian Moore · Answer

The debate over Medicare Advantage’s biggest disadvantage sparks varied opinions among clients and advisors alike. In my view, the traditional concern about restrictive networks is overstated and largely a relic of the past, as access has improved significantly. I firmly believe the advantages—cost savings, added benefits—far outpace any downsides, and that edge only grows as these plans continue to advance.

Answered by Brian Moore on March 26, 2025

Broker Licensed in OH

Answered by Brian Moore Medicare Insurance Agent

Melonie Wood · Answer

In my opinion, Medicare Advantage is a great alternative to Orginal Medicare & Part D, as Medicare Advantage is a "Pay as you go" you only pay IF you use your plan. Most plans have a cap with co-pays, Medicare Advantage includes many additional benefits such as OTC/Dental?Vision/Transportation/...

Answered by Melonie Wood on March 30, 2025

Agent Licensed in FL & AL

Answered by Melonie Wood Medicare Insurance Agent

Andrew Zurbuch, MBA · Answer

The Medicare Advantage plans that are on a HMO can be a disadvantage to the Insured if the Insured doesn't know how their specific Medicare Advantage plan works. An Health Maintenance Organization, H.M.O., network is more restrictive than a  P.P.O. which is a Preferred Provider Organization network. Also, a Medicare Advantage plan on a  Health Maintenance Organization network attempt to control costs. This controlling of costs can be a disadvantage to the Medicare Beneficiary. It depends on the claims.

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.

Nikki Rowland · Answer

The biggest disadvantage of Medicare Advantage are the limitation of provider choices which could affect access to care.

Answered by Lesley Burns on April 21, 2025

Broker Licensed in AR, MI, MO, NM & TX

Answered by Lesley Burns Medicare Insurance Agent

Robert Pennington · Answer

I don’t find any disadvantages as long as a PPO Plan is being used. I don’t use HMO Plans unless it’s a Chronic Illness Plan.

Voss Speros · Answer

This answer is provided in a video format. Watch the agent's video response here: https://medicareagentshub.com/questions/what-is-the-biggest-disadvantage-of-medicare-advantage#voss-speros

Steven Whetstine · Answer

The biggest disadvantage to a Medicare Advantage plan is the limited network of doctors and hospitals and care access.  If you choose to see a doctor or visit a hospital, out of network expenses can be very expensive and the plan may not cover out of network expenses at all.  Medicare advantage plans may only allow you to use certain durable medical equipment within the plan.

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.

Brian Krantz · Answer

Networks. You're limited to doctors and hospitals in the plan’s network, which can be a problem if you travel or need care out of state. Also, in states with medical underwriting, if your health changes later, you might not be able to switch to a Supplement plan down the line.

Answered by Brian Krantz on March 25, 2025

Broker Licensed in NY, AK, AL & 48 other states

Answered by Brian Krantz Medicare Insurance Agent

James Carlson · Answer

First is the network.  Second is the risk of having to pay the max oop annually due to a serious medical condition.  3rd, the plan is controlled by the insurance plan, not medicare.
Due to network limitations, proper care may not be available.  Many more disadvantages that a supplement plan would cover.

Marsha Reiniers · Answer

Medicare Advantage plans are managed health plans, and they may offer extra benefits not included with Original Medicare. You will want to research your options, both with a PPO plan and an HMO plan, and if you are a Veteran, perhaps look at a plan that addresses your specific health care needs. These types of plans are managed by the carrier, but the plan must meet the contract they have with Medicare to provide you the same benefits you would have with original Medicare. Because they are network driven, you will benefit better from your plan if you utilize in networks doctors and services. And depending on the plan and procedure, you may need a referral to a specialist from your primary care physician and possibly wait for pre-approval for some procedures. Be sure to research the plan(s) you are considering so you understand your out-of-pocket costs, known as the Maximum Out of Pocket or MOOP.

Answered by Marsha Reiniers on July 21, 2025

Agent Licensed in FL, GA, NC, PA, SC & VA

Answered by Marsha Reiniers Medicare Insurance Agent

Christopher Boyd · Answer

Two common complaints raised by seniors: 1) the insurance agent (over the phone or in person) did not explain the Maximum Out Of Pocket (MOOP) costs per year and 2) network restrictions or provisions and their implied costs of the Medicare Advantage plan. Will those network restrictions impact my travel across the USA or outside the country?

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.

Michael Andrews · Answer

In my opinion, the biggest disadvantage of the Medicare Advantage plans is the ability for doctors and hospital networks to undergo contract negotiations which may leave the client out of network for the rest of the year.

Answered by Michael Andrews on March 26, 2025

Broker Licensed in CT

Answered by Michael Andrews Medicare Insurance Agent

Christopher Palazzini · Answer

The denial of claims and needing a prior authorization from the company. Doctors can drop carrier at any time of the year leaving clients stranded and having to cancel all future appointments/surgeries. 

Max out of pockets can be high depending on program especially while out of network.

Bill Green · Answer

The biggest disadvantage of Medicare Advantage is that it typically comes with a network of doctors and hospitals, so you’ll want to make sure your providers are in-network to avoid higher costs. But for most people, this isn’t a big shift—it’s similar to the HMO or PPO group or marketplace insurance you’ve likely had throughout your working years. Just like before, staying in-network usually gives you the best coverage and cost savings. These plans often have low or even $0 premiums, which can make them a more affordable option than Medicare Supplement plans. Not everyone can afford a monthly premium for a supplement, and that’s okay—what matters most is finding the right balance between cost and coverage. There’s no one-size-fits-all answer, and that’s why working with someone who understands both options really makes a difference.

Answered by Bill Green on March 26, 2025

Broker Licensed in FL, AL, AZ & 19 other states

Answered by Bill Green Medicare Insurance Agent

Edward Givens · Answer

Limited Provider Networks
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.

Michael Ryan · Answer

Most are HMO plans that will restrict you to a provider network. The last several years there are PPO plans available in many areas that provide access to care outside of a network.

Bryan Smith · Answer

I’d say that sometimes a doctor has to submit attestations or evidence to justify certain procedures, since insurance companies might decide on coverage if the doctor isn’t actively involved.

Vincent Esposito · Answer

Advantage plans are network driven..  Advantage plans changed or can be discontinued from year to year.

Don Hudson · Answer

The biggest disadvantage would be that your current doctors are not in your network or changed networks. The downside is now you need to change networks, and all your doctors may not be in the same network

Answered by Don Hudson on March 30, 2025

Broker Licensed in FL

Answered by Don Hudson Medicare Insurance Agent

Lance Stanley · Answer

Medicare advantage plans do not offer the same level of choice. Most plans require their customers to see their drs and providers. Since MA plans can't cherry pick their their enrollees because they have to accept anyone that has Medicare and it sometimes can discourage some enrollees from using it because of the copays and deductables where as with a supplement they have very little out of pocket cost.

Answered by Lance Stanley on March 27, 2025

Broker Licensed in FL, AL, GA, MS & TX

Answered by Lance Stanley Medicare Insurance Agent

Karen Boudreaux · Answer

If it’s an HMO referrals can be inconvenient. And net work of doctors depending on the area and the plan.

Samantha Jellison · Answer

Networks, prior authorizations and referrals. 

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.

Shane Bullock · Answer

I have many clients who choose Medicare Advantage plans and it works very well for them. That said, no insurance is perfect. The most common issue I've seen with Medicare Advantage plans is when someone enrolls in a plan that doesn't allow them to see the providers that they want to see because of the network it uses. I usually see this when people enroll themselves in a plan, or when they call an 800 number they saw on TV or through the mail. People need to find a competent agent/broker that takes the time to do a thorough assessment before they recommend a plan. If you do run into issues like this, they should be available to help you find solutions.

Answered by Shane Bullock on March 11, 2025

Broker Licensed in UT, AZ, FL & 9 other states

Answered by Shane Bullock Medicare Insurance Agent

Phillip Lovelady · Answer

The biggest disadvantage of Medicare Advantage is the restricted provider networks. Typically, your MAPD plans come in the form of PPO or HMO.

Sandra Bailey · Answer

The disadvantage is making sure your doctors are in network. All physicians are not & some may start out in network & pull out of network later. There will be co-pays that you’ll need to pay & there is a max out of pocket.

Answered by Sandra Bailey on May 31, 2025

Broker Licensed in TN, AL, AR & 13 other states

Answered by Sandra Bailey Medicare Insurance Agent

Shane and Tammy Carpenter · Answer

The biggest disadvantage of Medicare Advantage is carriers have a Network of Doctors, Hospitals and more. Each Carrier could have a different Network. Always Review your Preferred Doctors and Hospitals.

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.

William Lewkowski · Answer

Medicare Advantage may sound good at first but as you age, potentially develop medical conditions, it can sometimes lead to limited options and costly out of pocket expenses.

Justin Scheiner · Answer

The biggest disadvantage of Medicare Advantage is the limited network of providers. You can check to make sure your preferred providers are in network while choosing a plan.

Answered by Aisha Saleem on March 13, 2025

Agent Licensed in MD & FL

Answered by Aisha Saleem Medicare Insurance Agent

Kim Cotten · Answer

Medicare Advantage plans can have a Limited Choice of Providers, Prior Authorizations, and Hidden Out-of-pocket costs.

Jose Solis-Flores · Answer

While Medicare Advantage (Part C) plans might seem appealing, it's crucial to understand the potential downsides. 

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.

Bob Thompson · Answer

Co payments can be a surprise. A supplement plan you pay the same each month. Medicare Advantage, you may have no medical co pay for a year or two and then hospitalized and have a $400 to $2000 co pay. It’s okay if you have prepared for this situation and unsettling if you have not.

Answered by Bob Thompson on March 25, 2025

Agent Licensed in IA

Answered by Bob Thompson Medicare Insurance Agent

Steven Bleicher · Answer

Prior Authorization, also called ‘Step Therapy” is when your Advantage plan company delays accepting a new and fairly expensive Rx, in their hope of finding a cheaper Rx for the same health issue. The delay can be ridiculously long, depriving you of the immediate medication that your doctor knows is your best choice. Moreover, the drug formulary of acceptable drugs can be changed at the drop of a hat during anytime of the year. Some will call that ‘bait and switch”!!

Answered by Steven Bleicher on May 29, 2025

Broker Licensed in AZ

Answered by Steven Bleicher Medicare Insurance Agent

Timothy Brown · Answer

Two of the biggest disadvantages of a Medicare Advantage plan are that they’re not accepted everywhere and the plans can change annually.

Diana Garner · Answer

The biggest disadvantage is limited provider networks and potential for limited access to care. 

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)

Steve Houchens · Answer

Probably in my opinion the main disadvantage would be having to work within a network, although I don’t see that as a major disadvantage due to most people are generally used to doing so with major medical coverage. There are some possible out of pocket cost but al long as you have been informed on what those are and understand your plan you know what you have to work with.

Answered by Steve Houchens on April 2, 2025

Agent Licensed in KY & TN

Answered by Steve Houchens Medicare Insurance Agent

Michael Pyers · Answer

Tied to a Specific network of Physicians and Facilities.  Must get approval from the plan for some procedures. Such as an MRI.

Gregg Matheny · Answer

In my opinion, the biggest disadvantage with Medicare advantage Is that your Cost could be anywhere from $0 dollars Up to a plan maximum amount of pocket (In some cases $10,000) throughout the year. Medicare advantage is definitely attractive because of the low monthly premium, but it has potential to be more expensive than a supplement plan. Also, The fact that some procedures require prior authorization from the insurance company can be a real sore spot too.

Answered by Gregg Matheny on March 25, 2025

Agent Licensed in AZ & UT

Answered by Gregg Matheny Medicare Insurance Agent

Leslie Helene Sussman · Answer

The biggest disadvantage of Medicare Advantage is carriers have a Network of Doctors, Hospitals and more.   Each Carrier could have a different Network.  Always Review your Preferred Doctors and Hospitals. 

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.

John L Herman Jr · Answer

Here are a few of the disadvantages of Medicare Advantage Plans…not all Doctor’s accept the Plan the client wants…Plans are often available in one area, but not just a few miles away…the biggest by far though is that at times the Insurance Carriers decides the limits on care and not the Doctor or the Client.

Fortunately, the upside is that good health care is being provided through Medicare Advantage Plans and clients need this option very much.

Joseph Peck · Answer

Networks, doctors can refuse at any time. Advantage plans can decline help. In an hmo the doctor decides where you go.

Cleo Martin · Answer

The biggest disadvantages to a Medicare Advantage is the limited network for the doctors and hospitals and the fact that it it managed care. The insurance companies are making decisions about how you will be treated. They can deny a treatment if they don't feel it is necessary.  With the networks, what if your doctor you want to see is not in their network?  Plus you have a large out of pocket for maximum out of pocket (moop). 

Cleo Martin
803-730-8368

Sean Davis · Answer

The biggest disadvantage of Medicare Advantage is carriers have a Network of Doctors, Hospitals and more. Each Carrier could have a different Network. Always Review your Preferred Doctors and Hospitals.

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.

Julie Joyce · Answer

Skilled nursing, which I can offer help for with an additional Indemnity product! Medicare Advantage plans only give you the first 20 days at a low copay in a skilled nursing facility, you need an additional policy for days 21 and on

Answered by Julie Joyce on March 25, 2025

Agent Licensed in PA, CT, DE & 9 other states

Answered by Julie Joyce Medicare Insurance Agent

Ami Fouts · Answer

In New Hampshire, you're not able to go back to a supplement plan if you originally signed up for an advantage plan without underwriting and can be denied coverage.

George Kolitsas · Answer

Medicare Advantage plans are network driven There are PPO's and HMO's, most of the time I am recommending a PPO plan to give you a little more freedom and flexibility. Also, prior authorizations and referrals can be common.

Answered by George Kolitsas on March 25, 2025

Broker Licensed in CT

Answered by George Kolitsas Medicare Insurance Agent

Helena Foutz, RSSA · Answer

If you have a Medicare Advantage HMO, you are limited to the doctors in the medical group you choose, and you are limited in which medical groups work with which HMO. For Medicare Advantage PPO plans, the biggest disadvantage is the copays and higher out of network costs and Maximum out of Pocket.

Answered by Helena Foutz, RSSA on March 4, 2025

Broker Licensed in CA, AK, AR & 12 other states

Answered by Helena Foutz, RSSA Medicare Insurance Agent

Ryan Raphael · Answer

Having to deal with prior authorizations. Although people are typically used to that anyway. There is often misconceptions about the network size but usually many doctors take several of the Advantage plans.

Answered by Ryan Raphael on March 5, 2025

Broker Licensed in MO, AZ, GA, IL & TN

Answered by Ryan Raphael Medicare Insurance Agent

Robert Helmkamp II · Answer

While Medicare Advantage Plans offer many additional benefits for no cost that are not covered by Original Medicare, like Dental, Vision, Hearing, OTC Cards, and Part B Premium Reductions, they are limited to a specific network of Doctors and Hospitals. If you use a doctor or have a procedure at facility that is not in the plans network, you will have a higher copay for these services or they may be denied and not covered by the plan. This could potentially lead to higher out-of-pocket costs.

Answered by Robert Helmkamp II on May 12, 2025

Broker Licensed in AZ

Answered by Robert Helmkamp II Medicare Insurance Agent

Christie Bondos · Answer

In my opinion, if you choose a plan with a limited network of providers and pharmacies or it doesn't cover all your drugs it's a disadvantage. Never, ever choose a plan "just based on Ancillary benefits like Dental, Vision, Hearing, or a certain Gym Membership benefit. Some people get caught up in a Food Allowance for example and forget this is a Medical Plan. Know what your medical and prescription needs are first.. A PPO network is always advantageous as well.

Answered by Christie Bondos on May 26, 2025

Broker Licensed in CT

Answered by Christie Bondos Medicare Insurance Agent

Fred Manas · Answer

Key Takeaways:

- 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.

Vachik Chakhbazian · Answer

is the potential limitation of healthcare providers and the need for prior authorization. Unlike Original Medicare, MA plans typically have restricted networks of doctors and hospitals, meaning you might not have access to your preferred providers.

Answered by Vachik Chakhbazian on July 1, 2025

Agent Licensed in CA, AL, AR & 22 other states

Answered by Vachik Chakhbazian Medicare Insurance Agent

Suzanne Lamperti · Answer

The disadvantages of a Neducare Advantage Plan are;
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.

Linda Davies · Answer

There's no one-size-fits-all answer to any plan option.   The optimal choice depends on individual circumstances, including your health status, budget, and preferences for flexibility in choosing doctors and hospitals. 

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.

Jack Mayer · Answer

In most cases these are In Network based plans that typically requires a referral by their primary care physician and you are covered only in your area except for urgent care and ER. Also, the plans can change each year.

Answered by Jack Mayer on July 14, 2025

Agent Licensed in CA & NV

Answered by Jack Mayer Medicare Insurance Agent

Robert Remin · Answer

The Maximum out of pocket in a bad heatlh year and if you are not in one of the four guaranteed issued states you are subject to underwriting when changing plans to Medigap and might not qualify once your guaranteed issued status is no longer available.

Answered by Robert Remin on May 19, 2025

Agent Licensed in NY, CT, FL & NJ

Answered by Robert Remin Medicare Insurance Agent

Michael Kim · Answer

That there are networks of doctors you will have to deal with. Meaning you have a network of doctors and specialist to choose from. So sometimes clients want a particular doctor or specialist and they might not be in the network.

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.

Aisha Saleem · Answer

The biggest disadvantage of Medicare Advantage is the limited network of providers. You can check to make sure your preferred providers are in network while choosing a plan.

Sonya Chandler · Answer

The biggest disadvantage is you have to follow the rules of the plan. Sometimes you have to get prior authorization for certain procedures. You also may have to use providers who participate with the plan.

Answered by Sonya Chandler on May 21, 2025

Agent Licensed in NY, AZ, FL & 5 other states

Answered by Sonya Chandler Medicare Insurance Agent

Lesley Burns · Answer

The biggest disadvantage of Medicare Advantage are the limitation of provider choices which could affect access to care.

Maci Mishler · Answer

Medicare Advantage can have huge disadvantages when it comes to networks. I don't care how attractive the extra benefits may be, because at the the of the day this is health insurance and that is our main focus--making sure you're covered when you need it!

Answered by Maci Mishler on June 9, 2025

Broker Licensed in NE, AR, KS & MO, ND, OK & TX

Answered by Maci Mishler Medicare Insurance Agent

Justin Hundley · Answer

The biggest disadvantage of Medicare advantage is probably the limited network of healthcare providers. Unlike Original Medicare or a Medicare supplement, which typically allows you to see any doctor who accepts Medicare, Medicare advantage plans usually require you to stay within a specific doctor and hospital network, much like a standard health plan that you may have had in the past. Due to this, you may be required to follow certain procedures such as getting referrals before seeing certain doctors. 

The trade off is that Medicare advantages plans often provide predictable cost sharing and many other benefits that may fit your healthcare needs.

Edward Cavelli · Answer

Cost shares, pay as you go can sometimes become an ongoing pain. 
Advantage is good while you are healthy and not utilizing may services.

Toni Johnson · Answer

The biggest disadvantage of Medicare Advantage is the limited network of providers. You can check to make sure your preferred providers are in network while choosing a plan.

Answered by Aisha Saleem on March 13, 2025

Agent Licensed in MD & FL

Soledad Ramirez · Answer

You have to stay in your network and if it's an HMO you have to obtain referrals to see your specialist doctors.

Tracy Brown · Answer

At MedWiseTrust, we are not promoters of the Advantage plans.  They do work for about 30% of our clients.  The biggest disadvantage of Advantage plans is the limited provider network and the potential for higher out-of-pocket costs.  We advise that only our healthy clients choose this option.  For people who need a lot of care or have costly healthcare needs we explain the benefits of Medigap plans.  60% of our clients choose Medicare supplements.

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.

Chris Bumgardner · Answer

You are limited to certain doctors and hospital's (HMO and PPO networks), and you may need referrals to see specialists, if you go out of network, it can cost more, or may not be covered at all.

Kilolo Thomas · Answer

Medicare Advantage plans in general, require you to stay within their network of doctors for lower copays/coinsurance. Some Medicare recipients prefer more flexibility in choosing their doctors opt for Medicare Supplemental plans in which they pay a monthly premium.

Answered by Kilolo Thomas on May 19, 2025

Agent Licensed in NJ, MS, NY, PA, SC & TX

Answered by Kilolo Thomas Medicare Insurance Agent

What is the biggest disadvantage of Medicare Advantage?

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