What is the biggest disadvantage of Medicare Advantage?

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.

Answered by Christopher Boyd on March 4, 2025

Agent Licensed in IN, KY, MI, OH, PA & TN

Answered by Christopher Boyd Medicare Insurance Agent

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

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

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.

Answered by Samantha Jellison on March 6, 2025

Broker Licensed in NC, FL & SC

Answered by Samantha Jellison Medicare Insurance Agent

What is the biggest disadvantage of Medicare Advantage?

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What is the biggest disadvantage of Medicare Advantage?

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Agent Locator

Medicare Agents HubA non-government resource website

Medicare Agents Hub
A non-government resource website