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.

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

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

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!

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!

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

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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