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

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

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.

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.

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.

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

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.

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.

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.

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.

Nikki Rowland · Answer

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

Answered by Phillip Lovelady on March 25, 2025

Agent Licensed in TX

Answered by Phillip Lovelady Medicare Insurance Agent

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.

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.

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

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.

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

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.

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

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

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.

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

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

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.

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

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.

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.

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.

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

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

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

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.

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

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

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.

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.

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.

What is the biggest disadvantage of Medicare Advantage?

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