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.

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

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!

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

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.

Steve 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 Brauer on April 17, 2025

Broker Licensed in AZ & CA

Answered by Steve Brauer Medicare Insurance Agent

Gary Henderson · Answer

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

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.

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

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

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?

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What is the biggest disadvantage of the Medicare Advantage plans?

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