What is the biggest disadvantage of the Medicare Advantage plans?

Question

Clarence &quot;Mark&quot; Christiansen · Accepted 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

William Gray · 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.

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.

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

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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