Why would you not choose a medicare Advantage plan?

Question

Larry Dalton · Accepted Answer

Medicare Advantage plans can be beneficial, but they come with certain limitations. These plans restrict your healthcare providers or services under the PPO (Preferred Provider Organization) and HMO (Health Maintenance Organization) networks. You often need preapproval for about 70% of procedures under a Medicare Advantage plan. You must have a preferred Physician as your primary physician, and a referral from your primary care physician is required to see other specialists in or outside your network.   

It's important to note that these plans are often designed with specific geographic areas in mind, which may limit your access to available providers outside of your local area. However, Medicare Advantage plans offer many additional services that traditional Medicare with Medigap plans may not provide, and they cover your prescription drug plans with zero to low monthly premiums.  Medicare Advantage plans are only good for one year and must be renewed yearly.

Lt Col Tim Brown · Answer

In fact, my wife and I did choose that route. We like it very well. There is no perfect plan on the market but it was certainly right for us. Most of what I provide people is Medicare advantage. Supplements are good plans but not as popular as they once were.

Answered by Lt Col Tim Brown on May 19, 2025

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

Answered by Lt Col Tim Brown Medicare Insurance Agent

Norman Smith · Answer

There are many reasons! 
The most important reason is, I prefer to have control over my health, rather than a privatized corporation! In an MA plan, you have to follow their rules, see their doctors, facilities, and get referrals before you can go anywhere. If you have a consultation with a practitioner, and find you don't like or trust him/her, you do not have the choice to look elsewhere! You are going to THAT DOCTOR! So my preference, on the major medical items, at least, I want to know that I have the options for the BEST treatments I can get and not worry about the costs either, because I chose the best by opting for Original Medicare, and an affordable supplement, that gives ME the control over who I see. Accepting an MA plan means you eliminate yourself from having coverage through top facilities such as The Mayo Clinic, The Cleveland Clinic, Johns Hopkins, Moffett, etc.
Also, I often see the annual deductible cost more than Original Medicare and a Supplement combined!  Why would you opt then to put yourself in a controlled box? You are most likely paying for your Part B already in most MA programs. If the annual deductible is more than the yearly supplement, then it truly doesn't benefit you.
MA Plans rarely travel with you because they are dependent on the local Network of Doctors, hospitals, and participating specialists. If you travel, this is of no use to you. Everything will be out of pocket or at least out of network. And if you travel internationally, the MA plan is absolutely no good for you, whereas the supplement plans give you a $50,000 lifetime, 80% reimbursement payment for any medical services outside the USA. 
Lastly, the consistency of changes to what the government allows for, and what the MA companies will cover, is constantly changing from year to year. So you have to review and babysit your medical each year! The doctor in the plan this year may elect not to accept it next year!
Don't get caught saving nickels to spend Benjamins on later!

Tony Capraro III · Answer

There are both Pros and Cons with Medicare Advantage! There are usually OOP (out of pocket maximums from $4500-$10,000 per year) and with Med Advantage the Insurance company makes the decisions on what surgeries are "necessary". We give client options between both Medicare Advantage and Medicare Supplement! We provide the Pros and Cons of both and let the client make the decision that's best for them! Let US help YOU!

Answered by Tony Capraro III on April 15, 2025

Agent Licensed in NH & ME

Answered by Tony Capraro III Medicare Insurance Agent

David Bell · Answer

If you are undergoing current, major treatment such as dialysis, chemotherapy, transplant or joint replacement, a supplement may be the better choice as premiums may be less than the comparitive out of pocket costs. Also if treatments or procedures will be well away from where you live there may be network issues if your Medicare Advantage options are HMO's. If you are in this situation, discuss the pro's and con's of both plans with your agent so they can best advise you. There are also places the Medicare Advantage plans are not available so for some there may not be a choice.

Answered by David Bell on April 15, 2025

Agent Licensed in ID, AZ, CA & 8 other states

Answered by David Bell Medicare Insurance Agent

Thomas Ashton · Answer

If you travel, you may not want a Medicare Advantage Plan, because they are territorial and are not accepted everywhere (except in emergencies). Your doctor or hospital can leave a plan at anytime throughout the year, but there are only certain times you can change plans, forcing you to have to find a new doctor or hospital.

Answered by Thomas Ashton on March 31, 2025

Broker Licensed in FL, AL, AZ & 6 other states

Answered by Thomas Ashton Medicare Insurance Agent

Ali Crouch · Answer

In some towns, hospitals do not accept Medicare Advantage. They can also be restrictive regarding billing codes and networks.

Angela Ellington · Answer

If you can qualify and afford a Medicare Supplement with Part D, you'll have the most freedom & flexibility to choose your providers, with access to any Doctor/Hospital that accepts Medicare in the entire US, with lower out of pocket responsibility than most Medicare Advantage PPO plans. Your authorizations come from Medicare, instead of an insurance company or medical group who will dictate where you can go and what will be covered. When facing a serious health issue, most people wish that they had this type of coverage if they are on Medicare Advantage and unable to purchase a Medicare Supplement plan. Medicare Advantage is not poor coverage, but there are limitations in their networks. They provide very comprehensive benefits, especially for people who prefer an HMO. Many people have adequate coverage on Medicare Advantage at a more affordable price.

Answered by Angela Ellington on May 19, 2025

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

Answered by Angela Ellington Medicare Insurance Agent

Steven Bleicher · Answer

I’m an advocate of a Med. Supplement. The reason is due to the high deductible associated with every MA plan. Most folks don’t realize that though the MA has no monthly premium, the reason is that it is government-subsidized. So, the “give and take” argument is that if you ever were hospitalized, that steep out-of-pocket cost would your responsibility. Plus, in the next calendar year, it starts all over again, likely at a higher expense due to our global inflation.

Answered by Steven Bleicher on June 8, 2025

Broker Licensed in AZ

Answered by Steven Bleicher Medicare Insurance Agent

Yasmery Vargas · Answer

You wouldn't chose a medicare advantage plan if you have employer retirement benefits or sucessfully enrolled into a medicare supplement.

DeeDee Whitlock · Answer

Most people do not choose a Medicare Advantage plan because they do not want the restrictions on network providers or want an insurance carrier in control of their medical care!

Chad Watkins · Answer

This answer is provided in a video format. Watch the agent's video response here: https://medicareagentshub.com/questions/why-would-you-not-choose-a-medicare-advantage-plan#chad-watkins

Cleo Martin · Answer

Because it has networks that you have to use.
It is managed care, meaning insurance companies make decisions about treatments instead of doctors.  And you have to pay just about everything you use it with deductibles and co-pays. There is a maximum out of pocket but it usually  thousands of $$. Going outside network can be very expensive.

Fred Manas · Answer

You might not choose a Medicare Advantage plan due to several factors, including limited provider networks, the need for prior authorization, potential for increased out-of-pocket costs, and the complexities of navigating the plans. Here's a more detailed look:
1. Provider Network Restrictions: Medicare Advantage plans typically require you to use doctors and hospitals within their network. This can be problematic if your preferred doctors or hospitals are not in the network, or if your plan changes its network, potentially leaving you unable to see your preferred providers. With Original Medicare, you can generally see any doctor who accepts Medicare, which is a large majority.  2. Prior Authorization Requirements: Many Medicare Advantage plans require pre-approval for certain medical services, procedures, or medications. This can lead to delays in receiving necessary care and can feel like an added burden. Original Medicare generally does not require prior authorization for most services.  3. Potential for Increased Out-of-Pocket Costs: While Medicare Advantage plans may have lower monthly premiums, they can also have higher out-of-pocket costs when you need to see an out-of-network doctor or hospital, or if your plan has complex rules regarding referrals or prior authorization. Some plans may also have higher copays or coinsurance than Original Medicare.  4. Navigating Plan Extras and Unexpected Changes: Many Medicare Advantage plans offer extra benefits like vision, dental, and hearing coverage, but these may not always be what they seem, and the plan can change its benefits or network at any time. This can be confusing and frustrating.  5. Difficulty Switching Plans Later: If you are unhappy with your Medicare Advantage plan and want to switch to Original Medicare, it can be difficult to do so, especially if you have had the plan for more than a year.

Steve Brauer · Answer

About the only reason I would not choose a Medicare Advantage Plan is if I traveled constantly and wanted to see Medicare providers out of my resident state. Other than that, I would absolutely choose an Advantage plan

Answered by Steve Brauer on April 18, 2025

Broker Licensed in AZ & CA

Answered by Steve Brauer Medicare Insurance Agent

Toni Chavez · Answer

Thank You for your question.  Medicarr Advantage Plansare a great option for seniors, but thrfe a limitations on getting care with doctors in the network.  Depending on the state you reside, there are robust networks which doesn’t tend to cause an issue for finding great doctors fir your healthcare needs.   It’s always recommended to talk to a broker. They are unbiased and and recommend based on your specific needs. There is no cost to use a broker we are compensated when we enroll you in a plan when I retire to do it needs analysis, which is beneficial for the client and providing solutions based on your needs.

Hope this answers your question.

Have a great day

Glenn Alterman · Answer

If you like freedom to choose your own providers without restrictions assuming they accept Medicare, than this is a logical choice 

If you want a package with dental, vision, transportation, a Visa card and network restrictions, than you can choose an MAPD plan.  Some MA plans have very few restrictions and very few benefits so you would need to weigh all of this out

Rene Apack · Answer

That's a perfect question. Many people have Medicare Advantage, and they love it.
If you do not want to incur yearly maximum out-of-pocket costs, you may choose to stay with Medicare and opt for a supplement.
Does that help?

Lawanda Radford · Answer

Hi, that’s a great question. A senior might not choose a Medicare Advantage plan due to concerns about limited provider choice, prior authorization requirements, and potential for unexpected plan changes. Working with a licensed professional can help you choose your best option.

Answered by Lawanda Radford on May 17, 2025

Agent Licensed in GA, AZ, FL & 10 other states

Answered by Lawanda Radford Medicare Insurance Agent

Why would you not choose a medicare Advantage plan?

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Why would you not choose a medicare Advantage plan?

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