What is the biggest disadvantage of the Medicare Advantage plans?

Question

William Gray · Accepted Answer

Medicare Advantage plans have netwrork restrictions and can cost more out of pocket for deductibles and copays. Your doctor who is in network now may not be next year and the plans change annually. 

If you are on a Medicare Advantage plan and exceed your first 12 months and have health problems you may never be able to apply for a Medicare Supplement in the future.

Steve and Sue Brauer · Answer

Probably the biggest perceived disadvantage to Medicare Advantage Plans is that you have to stay within the network of the insurance company that you have. In reality, if you live in the Phoenix area, or Florida, the networks are VERY robust and easy to navigate.

Answered by Steve and Sue Brauer on April 17, 2025

Broker Licensed in AZ & CA

Answered by Steve and Sue Brauer Medicare Insurance Agent

Lt Col Tim Brown · Answer

As an agent and broker of 37 years, my wife and I chose a Medicare advantage plan. No plan is perfect, supplements aren’t either.  The big disadvantage is Part B drugs given in the hospital is 20% to you which would push you to the max out of pocket in the plan and then you’d be at 100% coverage.  Max OOP typically between 5k and a little over 6k

Tim Brown 
Contact us.

Gary Church · Answer

There are pros and cons with any health plan. What is the most significant disadvantage of the Medicare Advantage plans? Networks!! Freedom to see the doctors you prefer. Your Medicare Advantage plan manages your care with referrals.

Answered by Gary Church on July 22, 2025

Broker Licensed in Ca, AZ, NV & TX

Answered by Gary Church Medicare Insurance Agent

Norman Smith · Answer

It’s the passing of control of your health to a Limited Provider Network If you can compromise the thought of not choosing the best Practitioners, Specialists and Hospitals to best assure your health needs, whenever and wherever they are, then you should be satisfied.  They his eliminates facilities such as Moffett, John’s Hopkins, The Cleveland Clinic, The Mayo Clinic, as recognizable facilities to consider. 
Now you also may find that the Doctor who accepts an MA Plan today, won’t accept that next year as cuts and limitations are pushed back MORE on the  patient financially. There is a lot of stress and babysitting with a MA plan, that you don’t have with keeping Original Medicare and a good supplemental policy.

William Lawler · Answer

The biggest disadvantage of an Advantage plan is that most have networks. You must go to a doctor that is in the Advantage plans network. When I am looking at Advantage plans for a client, I make sure to choose one that their doctors` accept.
Bill Lawler

Clarence &quot;Mark&quot; Christiansen · Answer

The biggest disadvantage of the Medicare Advantage plans is the negative publicity surrounding the insurance, the negative sentiment and fake news making Medicare Advantage seem like a bad idea. As an independent Medicare agent for the past 18 years and a Medicare Advantage member for the past 5 years, I have no regrets and if I could do it all over again, would stick with Medicare Advantage. OK, there are plusses and minuses with Medicare Advantage but the program is overseen by the Federal Government. That's CMS, the Centers for Medicare Services. By law, Medicare Advantage must be "at least as good as" original Medicare. Medicare Advantage members are protected by an out of pocket maximum so that's probably the best thing about the program. On the flip side, many doctors don't like Medicare Advantage because it's more work for them. Some procedures require prior authorizations so the additional paperwork is not popular among the medical profession. But, I have yet to hear of a medically necessary procedure that has been denied by any Medicare Advantage plan.

Answered by Clarence "Mark" Christiansen on April 2, 2025

Agent Licensed in WI, AZ, CA & 16 other states

Answered by Clarence "Mark" Christiansen Medicare Insurance Agent

Jonathan Potter · Answer

The biggest disadvantage for Medicare Advantage would be a couple of things. If you see doctors that are not in network then it won't really work for you. If you are someone who has places to live in different states and see doctors in those states then it might not work for you. If you are someone who has many chronic conditions which would make you pay hundreds of dollars in copays with MAPD then it might not be the best.

Answered by Jonathan Potter on July 14, 2025

Broker Licensed in UT, AZ, CA & 14 other states

Answered by Jonathan Potter Medicare Insurance Agent

Don Hudson · Answer

One of the biggest disadvantages to Medicare Advantage plans you need to use doctors in certain networks. Another disadvantage is the Maximum Out Of Pocket can be very high.

Michael Caldwell · Answer

I would say the biggest disadvantages can be limited networks, especially in an HMO, and increased out of pocket costs.

Jason Hark, CMIS · Answer

The biggest downside to Medicare Advantage plans is that you gotta stick to their list of doctors and hospitals. If your doctor ain’t in their network, you might have to pay more — or it might not be covered at all.

Answered by Jason Hark, CMIS on June 4, 2025

Broker Licensed in IL, AL, AR & 16 other states

Answered by Jason Hark, CMIS Medicare Insurance Agent

Edward Wooten · Answer

Majority of advantage plans are similar to plans you may have through an employer. Including major medical coverage you may have also received vision, dental, hearing. Advantage plans will have a network of doctors you may choose from, coverages and the max out of pocket may be adjusted from year to year, and flexibility to choose a different plan each year.

Answered by Edward Wooten on July 13, 2025

Broker Licensed in IL & MO

Answered by Edward Wooten Medicare Insurance Agent

Michelle Sparks · Answer

There are many advantages when enrolled in a Medicare Advantage Plan. The biggest issue that folks need to think through before enrolling in an Advantage Plan vs. a Supplement/Medigap plan is the ability to switch if you want a plan to cover more of you medical costs. 

When you turn 65, you have 6 months to enroll in a Medicare Supplement with guaranteed issue, regardless of health or pre-existing conditions. 

If you elect a Medicare Advantage plan at 65, you have 12 months to switch to a Medicare Supplement and receive the same guaranteed issue. However, if you wait beyond the 12 months- you will be subject to underwriting (e.g. health exam) and risk being denied coverage. 

In summary, assessing your financial and physical health when turning 65 are key critical factors to deciding whether to go with a Medicare Advantage or Medicare Supplement. There is no one right decision, these are very individual decisions that should be made with the assistance of an experienced broker that can educate you on all the details- so you are confident that you are making the best decision possible for YOU!

Angela Ellington · Answer

There are a couple of disadvantages to enrolling in Medicare Advantage. Having to wait for referrals and authorizations are the main issues that my clients run into. Another issue can be paying more to go out of network with PPOs.

Answered by Angela Ellington on June 10, 2025

Agent Licensed in CA, AZ, FL & 9 other states

Answered by Angela Ellington Medicare Insurance Agent

Diana Garner · Answer

Limited provider network and potentially limited access to care. Depending on the plan you are enrolled in, you could have a Health Maintenance Organization (HMO) network, a Preferred Provider Organization (PPO) network, or a Private Fee-for-Service (PFFS) network.

Answered by Diana Garner on May 7, 2025

Broker Licensed in KY, FL, IN, OH & TN

Answered by Diana Garner Medicare Insurance Agent

Mary Salmon · Answer

The biggest disadvantage to Medicare Advantage plans are the copays, coinsurance and networks. While most Advantage plans are low or no premium, the out of pocket expenses can really add up. A lengthy hospital stay with a surgery can cause a major financial hardship for Medicare beneficiaries.

Answered by Mary Salmon on May 6, 2025

Broker Licensed in TX & OK

Answered by Mary Salmon Medicare Insurance Agent

Chad Watkins · 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-the-medicare-advantage-plans#chad-watkins

Lynn C Shurtleff · Answer

Medicare Advantage plans are mostly network based plans so the physicians and facilities available could be limited. This is going to depend on the carriers and the networks where you live. These can vary greatly so you want to be sure to check all of your providers and not be misled. I hear from beneficiaries that an agent told them with a PPO they could see anyone and just pay the higher copay, I just was told this a few days ago by someone referred to me. This is not true, the provider has to agree to accept and bill the PPO plan and they are not required to. Network based plans is the biggest disadvantage.

Answered by Lynn C Shurtleff on August 24, 2025

Broker Licensed in TN, AR, CO & 6 other states

Answered by Lynn C Shurtleff Medicare Insurance Agent

Cindy Clonts · 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-the-medicare-advantage-plans#cindy-clonts

Valentina Gatewood · Answer

The biggest disadvantage of a Medicare Advantage HMO is having to use one network, the PPO's biggest disadvantage are fees.

Doris Youngman · Answer

In many cases, you get what you paid for. You get money back? You get groceries? Why groceries in the health insurance plan? 

Disadvantage is the network and referrals. Most cases, referrals are needed to see specialists. Depending on the insurance company, you have NO selection of a specialist because the primary care doctor sends you to his/her buddy. No choice in the matter.

If you go with a PPO plan, you do have the freedom to call any doctor that takes your plan or outside your plan if you are willing to pay more than an in network specialist.

If you have a chronic issue like diabetes, cancer, some arthritic conditions, it is cheaper in the long run to purchase a Medicare Supplement plan.

Janet Cruz · Answer

The biggest disadvantage about having an advantage plan is the limited provider networks and higher out of pocket costs when you go out of networks. It’s also a disadvantage if you live in múltiple states. Your limited to care based on your location, sometimes, it doesn’t travel with you.

Answered by Janet Cruz on June 15, 2025

Broker Licensed in FL

Answered by Janet Cruz Medicare Insurance Agent

Donna Walbert · Answer

There are many advantages to the advantage plan, but it is important to note the disadvantages as well. One being is they are network based. It is extremely important to ensure your primary care provider and all specialists are within the network offered through the carrier. If not, the out-of-pocket costs will be substantially higher. The second disadvantage is it can be terminated (as an area, not as an individual) any time throughout the year. Another disadvantage to the Medicare Advantage Plans is the fact they are not guaranteed to be renewable every year. It is crucial to review the Annual Notice of Change sent in the Fall, so a proper comparison can be made during open enrollment between the current plan and the new available plans for the following year.

Answered by Donna Walbert on August 27, 2025

Broker Licensed in WI, CO, FL & 8 other states

Answered by Donna Walbert Medicare Insurance Agent

James Schneider · Answer

It is a network driven plan with different rules than original Medicare and changes from year to year

Fred Manas · Answer

The biggest disadvantage of Medicare Advantage plans is their limited provider networks and potential for restricted access to specialists and care outside of the network. This means you may not be able to see your preferred doctors or specialists, especially if you live in a rural area or travel frequently. 
Elaboration:
Restricted Provider Networks:
Medicare Advantage plans typically require you to use doctors and hospitals within their network for full coverage. This network is often limited to a specific geographic area. 
Access to Specialists:
You may need a referral from your primary care physician to see a specialist, and this referral process can be cumbersome. 
Out-of-Network Costs:
If you seek care outside the network, you may have to pay significantly higher out-of-pocket costs or may not receive any coverage at all. 
Limited Geographic Coverage:
MA plans may not offer coverage when you travel outside of their service area. 
Plan Changes:
Medicare Advantage plans can change their provider networks or benefits, including drug formularies, throughout the year, which can disrupt your care. 
Potential for Higher Costs:
While MA plans may offer lower monthly premiums, they can have higher out-of-pocket costs, including copayments, deductibles, and coinsurance. 
Prior Authorization:
You may need prior authorization from your plan before receiving certain services, which can cause delays in care. 
Aggressive Marketing:
Some MA plans use aggressive marketing tactics that may not fully disclose all the limitations of the plan.

Gary Henderson · Answer

YearlyMax out of pocket costs are high
The more perks they offer, the higher the max out of pocket costs

Mike Henry · Answer

Full of deductibles and copayments. Company or Dr can we quit being used without letting you know. Doesn’t travel well

Marcie Barnes · Answer

The type of coverage one chooses is personal.  Something that is a disadvantage for one person may nit be a disadvantage for another.

A thorough needs analysis is needed to determine what type of coverage is best for each individual.

Jaye Maxx Alexander II · Answer

Disadvantages of Medicare Advantage plans include: 

Limited doctors and hospitals: These plans restrict the providers you can use.

Higher costs for serious medical needs: If you require a lot of medical care or complex treatment, 

Medicare Advantage plans can be more expensive.

Preauthorization and coverage approval: You may need approval before certain treatments are covered.

Covered doctors may change: The network of providers can change, affecting your access to care.

Potential plan limitations: You might get stuck in your plan, making it difficult to switch out later.

Medicare Advantage (MA) is a private alternative to traditional Medicare. This type of plan must equal the coverage provided by original Medicare, but it typically provides more benefits, particularly vision, dental, and hearing services. Most MA plans include prescription medication coverage. People enrolled in original Medicare are covered by Part A for hospital services and Part B for outpatient care, but they must buy stand-alone Part D plans for prescription coverage.

The tipping point for private Medicare coverage came in 2023, when more than half of Medicare enrollees were covered by MA plans for the first time. But MA may not be right for you. Some people are better off with traditional Medicare

Betty McCarty · Answer

The biggest disadvantage of Medicare Advantage plans is usually restricted access and unpredictable costs.
•	You’re typically required to use doctors and hospitals within the plan’s network.
•	Out-of-network care can be costly or not covered at all—especially problematic in rural areas.
•	While premiums may be low, copays and deductibles can add up.
•	Unlike Original Medicare, Advantage plans may not cover care outside your local area unless it’s an emergency.
•	If you start with Medicare Advantage and later switch to Original Medicare, you may not qualify for a Medigap policy without medical underwriting—especially if you have preexisting conditions.

Kimberly Hargis · Answer

I personally do not see a disadvantage when it comes to Medicare Advantage compared to Original Medicare. Original Medicare has no max out of pocket and no extra benefits. No drug plan is included. Medicare Advantage has a max out of pocket, drug plan, and lot's of extras including some plans giving gym memberships, dental, vision, and hearing.

Answered by Kimberly Hargis on May 29, 2025

Broker Licensed in TN, FL & KY

Answered by Kimberly Hargis Medicare Insurance Agent

Russell Scott · Answer

The "disadvantage" of MA plans is similar to comparing the experience of purchasing a lemon from a bad car dealer. The plans themselves generally aren't leading to a particular disadvantage in and of themselves. It's often the person who sold the plan who didn't do their job properly regarding drug formulary considerations, network limitations and setting out-of-pocket expectations for the Medicare beneficiary. MA plans are appropriate for some people and for other they're not. Just like selling someone a sedan when they really needed an SUV. It drives down the road. It has a gas pedal but it might just not do all the things that the consumer needs it to do for them.

Answered by Russell Scott on June 13, 2025

Agent Licensed in OK, MO & TX

Answered by Russell Scott Medicare Insurance Agent

Lyle Affleck · Answer

Medicare Advantage plans  have both advantages and disadvantages. Among the disadvantages is the fact that MA plans often come with deductibles and co-pays. The average deductible (for 2025) is around $4,700. The deductible resets every January 1st.

Medicare Advantage plans will also restrict your access to certain medical networks, dictated by the issuing insurance carrier.

Kerwyn Jones · Answer

1. Restrictions on providers 
2. Only contractually good for 1 year
3. Referral needed for HMOs
4. Larger Max of Pocket costs

John Pope · Answer

When I sit with a potential client we review their needs based on doctors, specialists, medications, finances and lifestyle. The times I find that MAPDs don’t fit their need is if a specialist or doctor isn’t in network or they do a lot of traveling. Reason being is an MAPD refers you to other doctors or specialists within a medical group.

Answered by John Pope on April 25, 2025

Broker Licensed in CA, FL, MO & OH, OR, TN & WY

Answered by John Pope Medicare Insurance Agent

What is the biggest disadvantage of the Medicare Advantage plans?

Agents: Share Your Expertise

Seniors: Ask a Question of Your Own

Related Questions

Agent Locator

Medicare Agents Hub
A non-government resource website

What is the biggest disadvantage of the Medicare Advantage plans?

Agents: Share Your Expertise

Seniors: Ask a Question of Your Own

Related Questions

Agent Locator

Medicare Agents HubA non-government resource website

Medicare Agents Hub
A non-government resource website