Why do some people regret choosing a Medicare Advantage plan over Original Medicare?

Question

Marsha Reiniers · Accepted Answer

If your health situation has dramatically changed, some people may wish they had a Medicare Supplement plan - usually due to choice of physicians or healthcare facilities, as Medicare Advantage plans are network driven. And it is important to note that even though your PPO plan allows you to 'see any provider of your choice,' that provider still has to agree to seeing you out of network. So that can be problematic in some cases and make them wish they had chosen a Med Supp plan. Both types of plans have their advantages and disadvantages, and it is important to understand the differences between both before making your own healthcare decision.

Answered by Marsha Reiniers on April 7, 2025

Agent Licensed in FL, GA, NC, PA, SC & VA

Answered by Marsha Reiniers Medicare Insurance Agent

Lt Col Tim Brown · Answer

First you have to stay enrolled in Medicare to have a Medicare advantage plan. It’s just that the advantage plan pays instead of Medicare. I don’t see much regret for advantage plans. I’m on one myself and I’m very happy with it. There is no perfect plan so what do people not like? Sometimes their doctor is maybe not on the plan, some approvals are needed but that’s the same under group insurance plans. The thing I don’t like myself is that Part B drugs you pay 20%. This is expensive and in that year you would hit your maximum out of pocket. But good plans? Yes.

Answered by Lt Col Tim Brown on April 11, 2025

Broker Licensed in TN, AL, CO & 10 other states

Answered by Lt Col Tim Brown Medicare Insurance Agent

Norman Smith · Answer

I don’t know! MA plans are helpful if you are staying local with no travel; your doctor accepts the plan now, and it pays your Part B, and your Prescriptions. But what is the Co- Pay, the deductibles, and Maximum Out-of-pocket costs? But you have NO CHOICE OF DOCTORS, No COVERAGE when you travel as you are OUT OF NETWORK, and cannot see the specialist facilities such as Moffett, Mayo, and the Cleveland Clinic. You give complete control of your health to a group of individuals to decide IF you can see someone and cover you.

Answered by Norman Smith on April 19, 2025

Agent Licensed in FL & PA

Answered by Norman Smith Medicare Insurance Agent

Tony Capraro III · Answer

What we've seen in helping our clients with Medicare planning-is that when you go with a Medicare Advantage Plan -the Insurance company will make the decisions on what they will cover and not cover. Another important difference is with Original Medicare as long as your doctor(s) take Medicare you are covered -with a Medicare Advantage Plan-you'll be working with a PPO or HMO type organization and you NEED to make sure YOUR doctors are Part of that plan! Medicare Advantage plans change year to year too! We have several situations this year where Doctors who were prior a part of the network are NO longer in the network! Work with someone who can go over all the Medicare "alphabet soup" and who can offer both: Medicare Supplement/Medigap AND Medicare Advantage and can give you the Pros and Cons of both so YOU can make smart decisions!

Answered by Tony Capraro III on April 7, 2025

Agent Licensed in NH & ME

Answered by Tony Capraro III Medicare Insurance Agent

Michael Denniston · Answer

Medicare Advantage plans usually have a defined network of doctors that are in their network. The biggest objection i hear is doctors choice, for some people the Advantage plans are great, and usually do offer have extra benefits. For more details contact us. (888) 589-4403.

Answered by Michael Denniston on June 22, 2025

Agent Licensed in FL, AL, AR & 11 other states

Answered by Michael Denniston Medicare Insurance Agent

Steven Graves · Answer

That’s a great question—while Medicare Advantage plans work well for many, some people do end up regretting their choice. Here are the common reasons why:

1. Limited Provider Networks
Medicare Advantage plans often require you to use a network of doctors and hospitals. If your preferred providers aren’t in-network, you might face higher costs or have to switch doctors.

2. Prior Authorization and Referrals
Many Medicare Advantage plans require prior approval for certain tests or specialist visits, which can delay care or add hassle.

3. Variable Coverage and Benefits
Benefits, premiums, and out-of-pocket costs can change every year, which means you might pay more or lose certain coverage unexpectedly.

4. Surprise Costs
Even with $0 premiums, copays, coinsurance, and deductibles can add up—especially for hospital stays or specialty drugs.

5. Travel Limitations
Most Medicare Advantage plans have limited coverage outside your service area, which can be a problem if you travel frequently.

Bottom line:
Medicare Advantage can be a great fit if you want extra benefits and lower premiums—but if you value flexibility, stability, and predictable costs, Original Medicare with a Medigap plan might be a better choice.

Would you like help reviewing your current plan or exploring other options?
Call us at Medicare4USA.com    214-989-7900

Terri Reagin · Answer

I think it is a combination of seeing negative things written about them or hearing the doctors complain and failing to prepare for the out of pocket costs such as hospitalization or a cancer diagnosis where the bills could be higher. There are plans that can cover those expenses that are pretty low cost. Ask your agent about them for a better experience with your advantage plan.

Answered by Terri Reagin on July 7, 2025

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

Answered by Terri Reagin Medicare Insurance Agent

Anthony Castelluccio · Answer

There are a few different reasons why people regret going with a Medicare Advantage plan vs Original Medicare. They don't realize the full cost of what they could pay year after year on a Medicare Advantage plan. The Maximum Out Of Pocket (MOOP) on most plans are over $7000 and if you are dealing with some major health concerns you could pay that for multiple years. The other reason is on a Medicare Advantage plan, you have to make sure your Dr's are in network and the Dr's can drop in and out of network year after year.

Answered by Anthony Castelluccio on April 3, 2025

Agent Licensed in PA, DE, MD, NJ & VA

Answered by Anthony Castelluccio Medicare Insurance Agent

William Lewkowski · Answer

Medicare Advantage requires you to utilize a specific provider network for your care. You do not have the freedom to go to any physician and any hospital and health system. Also, Medicare Advantage requires pre-approval of many medical procedures. Also, depending on your health issues, you may have significant out-of-pocket expenses. And if you want to leave Medicare Advantage and change to traditional Medicare with a Medicare Supplement (medigap), you may be denied because of a pre-existing condition.

Answered by William Lewkowski on April 10, 2025

Broker Licensed in TN, AL, AR & 30 other states

Answered by William Lewkowski Medicare Insurance Agent

Jeffrey Jon · Answer

Medicare Advantage plans can have high out of pocket costs. if someone has health issues that require lots of maintenance, then they may be paying those high out of pocket costs, and then they can get into the cycle of making payments for past services and accumulating more for current services. 
Doctors may change from year to year as to whether they will accept a certain plan or not, and then the patient with the MA / MAPD plan will have to look for another doctor. 
You must also remember that the 20% of orginal Medicare has no ceiling, which can also be costly for someone with a lot of medical issues.

Steven Bleicher · Answer

I'm putting my teacher's hat on first. Original Medicare (established in 1965) has always only referred to Medicare Parts A (IN-Patient Hospital) and B (OUT-Patient doctor visits). 

So, your question should read: Since the Advantage plan is Part C/D, the inquiry should say: What are the differences between Parts A, B, C and D?  

Unfortunately, due to the current administration's edicts about healthcare, since a Medicare Advantage is subsidized BY the Federal Govt., the benefits of these "MA" plans can change at the drop of a hat, I'm afraid. In addition, the expression known as "Prior Authorization" has proven to be highly controversial. Here's how: there are times when a doctor forgets to get your insurance firm's approval for a simple procedure or even a prescription drug. In the latter case, there's what's known as "step therapy" where a patient will be forced to use a different and cheaper drug for your condition than the one initially prescribed. Weeks can go by where you are not using the best possible drug for your condition!  Moreover, if a treatment has also NOT been submitted to your Advantage plan's company in advance, that can also be delayed for awhile, too. 

So, if you can afford a monthly Med. Supplement premium, that will always be your best bet.

Michael Pyers · Answer

We have quite a few people who have had advantage plans and have become ILL. The copays, coinsurance, large out of pocket expense have caused these people to rename them to Disadvantage Plans. Agents really like to sell Advantage Plans, as the compensation is quite a bit more that of Medigap plans.

Answered by Michael Pyers on May 2, 2025

Broker Licensed in OH & MI

Answered by Michael Pyers Medicare Insurance Agent

Barbara Barnes, CMIP® · Answer

The claims risk in Medicare Advantage is higher than it is in Original Medicare with a Supplement. The managed care requirements are also much more tedious, meaning that the insurance company must agree with the treatment plan before they provide coverage. As long as your need for healthcare is low, Medicare Advantage is great - it’s usually low-premium and the copays for healthcare services aren’t bad. But when you get sick and they start arguing with your doctor and denying the treatment plan he/she recommends, that delays care and causes stress. Also, as you use more frequent care, the copays for each service can really add-up and become expensive. Lastly, the limited network of a Medicare Advantage Plan can also be one a problem when you need care but the network doctor can’t see you for months or you need a bed in a Skilled Nursing Facility and there are no available beds in the in-network facilities. When you’re extremely sick, you want more options, not to be restricted. Medicare Advantage plans are restrictive by nature, to keep premiums low and to allow them to make a profit.

Answered by Barbara Barnes, CMIP® on June 6, 2025

Agent Licensed in PA

Answered by Barbara Barnes, CMIP® Medicare Insurance Agent

James Stang · Answer

Medicare Advantage Plans have a network you have to use where Original Medicare with a Medicare Supplement do not. The MOOP (max out of pocket) could also be higher than the annual premium for a Medicare Supplement, meaning in a year where you have multiple hospital stays a Medicare Advantage could cost more.

Answered by James Stang on July 7, 2025

Agent Licensed in OH

Answered by James Stang Medicare Insurance Agent

Valentina Gatewood · Answer

The options to use Original Medicare covered 80% of of Part A and Part B. All other cost would be your responsibility. Medicare Advantage can help minimize or eliminate that 20% responsibility.

Harold Randolph · Answer

Some people regret choosing medicare advantage, also known as Medicare part C, over original Medicare with a Medigap because of the out-of-pocket expenses.

People choose Medicare advantage because of the low cost upfront. Medical advantage includes additional benefits, like a drug plan, some limited dental vision and hearing. And the cost is zero dollars without a dental upgrade.

This may look enticing, and when you add a hospital indemnity to cover the out-of-pocket expenses for being hospitalized, it’s not a horrible plan. When compared to having a supplement, there are no surprise charges. 

If you go with original Medicare, you will have to buy your own dental vision hearing, and the cost for a drug planer on top of the cost of the Medigap. 

If you have additional questions, you can always reach out to a broker like myself. 

Harold Randolph 269-339-4433 or you can email me at HRandolph@asb.insure.

Dorothy Lam · Answer

There could be several reasons, one of which is a change in the doctor and hospital network. If a member's doctor or hospital is suddenly not in their advantage plan network, then their care can be disrupted. Another reason may be that the member gets ill and incurs more copay costs than they are used to and wishes they had more coverage. A Medicare Supplement covers more medical costs as compared to an advantage, though for an additional premium. These are risks that an Advantage plan member needs to take into consideration, going into an advantage plan with their eyes wide open, knowing that no one has a crystal ball to predict the future.

Answered by Dorothy Lam on April 16, 2025

Agent Licensed in IL, IA & IN

Answered by Dorothy Lam Medicare Insurance Agent

Mike Henry · Answer

Many limitations on Medicare advantage plz as that normal supplement cover. Testing Dr,s and other procedures

Toni Chavez · Answer

Great question!  As with everything there are pros and cons the pro with Medicare advantage is the premium of the plan, which a lot of times is zero monthly cost and you can budget with the plans max out of pocket.  Plus most of the plans have additional benefits life dental/vision/hearing/fitness coverage. 

 
The con is using a network, but I don’t really say this is a bad thing as most networks in the major cities have robust network of doctors and specialists.

Original Medicare in my opinion has a big con which is Original Medicare only covers 80%, which leaves you open to a 20% bill everytime.  If you have a year where you’ve been sick and have had to visit the doctor multiple times or have a hospital stay that can hit you hard financially.  There is no annual or lifetime cap with Original Medicare (Part A & Part B)


Hope this gives some insight.

Be well!
Toni Chavez
Medicare Broker

Todd Bostic · Answer

Because with a Medicare Advantage plan you have copays for all of your procedures with the exception of probably seeing your primary care doctor and with original Medicare, when you get a Medigap plan, you don’t pay anything other than your monthly premium.

Answered by Todd Bostic on July 8, 2025

Broker Licensed in TX, AL, AZ & 12 other states

Answered by Todd Bostic Medicare Insurance Agent

Rodolfo Rojas · Answer

It depends on the customer's need analysis. Medicare Advantage has numerous of plans in specific areas. It is the agent who you are working with to answer all questions and make sure the Medicare beneficiary understands all the covered services and not covered. 
Medicare Advantage may cost you a monthly of zero, which is not what social security takes for your Medicare Part B, is for the plan, but it may have certain cost share, and copayments. 
It also has many extra benefits. 
Make sure you work with an agent that will check all your needs.

Glenn Alterman · Answer

They regret the lack of flexibility and freedom to choose any doctor in the United States. Free always means fewer choices

Calvin Fritz · Answer

The main reasons are:
Limited provider network, higher out of pocket costs, referrals and authorizations, plan changes year to year, traveling in and out of state.

Because these issues often only become apparent after someone enrolls, many people don’t realize the limitations until they need care that isn’t covered or are faced with high out-of-pocket costs. It's essential to compare all your options carefully to ensure the plan you choose aligns with your health needs and preferences.

Maci Mishler · Answer

Some people come to regret a Medicare Advantage plan because they don't realize what some of their care will cost. For example, some things people use every month, like oxygen, can be very expensive and that client would have been better not going with Medicare Advantage.

Answered by Maci Mishler on June 9, 2025

Broker Licensed in NE, AR, KS & MO, ND, OK & TX

Answered by Maci Mishler Medicare Insurance Agent

Josh Vojtush · Answer

Even if you regret choosing a Medicare Advantage plan, you MIGHT be able to go back to Medicare with a Medicare Supplement. Timing, health, and your state of residence can all play a part in determining what is possible. With Medicare Advantage, network problems and medication/doctor changes might require a plan change which may result in different levels of benefits and costs. It's usually a "package" deal, to fix one thing you might break another, which is not common but definitely can be difficult to deal with as a consumer. To me, it's fun helping people figure things out!

Answered by Josh Vojtush on April 28, 2025

Broker Licensed in OH, FL, IL & MI, NC, SC & VA

Answered by Josh Vojtush Medicare Insurance Agent

Why do some people regret choosing a Medicare Advantage plan over Original Medicare?

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