Are Medicare Advantage Plans Right for You?

While most of us prefer not to think about getting older and the details that come with it, it’s essential to plan appropriately for retirement. This gives you insight into your future lifestyle and can help you make the appropriate changes beforehand. However, it’s important to note that Medicare isn’t always the best choice when looking for healthcare.

This is especially true for Medicare Advantage plans. Keeping this information in mind will help you avoid issues you may have otherwise encountered.

So, what is the downside to Medicare Advantage plans? Let’s explore the key details you need to know.

Original Medicare vs Medicare Advantage

To better understand the drawbacks of a Medicare Advantage plan, you’ll need to first understand the differences between this type of coverage and original Medicare.

The primary discrepancy is where you’re able to receive coverage. With original Medicare, you can go to any hospital in the United States that accepts Medicare coverage. You also don’t need a referral to see a specialist.

This means those who use original Medicare will have a much easier time receiving the care they need. They’ll also be less likely to be denied coverage.

In contrast, Medicare Advantage plans can only use doctors who are in the plan’s network. Depending on where you live, it may be difficult to find someone who accepts your insurance.

It’s worth noting that this only applies to non-emergency care. During an emergency, you’ll receive treatment and can figure out the details later. You’ll also likely need a referral to see a specialist, making it more difficult to schedule these types of appointments.


Medicare Advantage costs vary depending on the care you need and the provider you work with. You might also have to pay a substantial premium, causing you to spend more, on average, compared to original Medicare.

With the original plan, you can purchase Medigap coverage to pay your out-of-pocket costs. You can also use coverage from a union, former employer, or Medicaid. Medicare Advantage doesn’t allow you to purchase Medigap.


Regarding prescription drugs, you often can’t integrate a separate Medicare drug plan. You’re limited to the drug coverage that’s built into your existing plan. You might also need to get approval for your plan before it can cover certain supplies and services.

Original Medicare doesn’t have these restrictions in place. Because of this this, you may have trouble researching “Medicare Advantage doctors near me.”

Foreign Travel

Keep in mind that Medicare Advantage plans don’t cover medical care outside of the United States in most circumstances. If you’re injured or fall ill while abroad, you’ll pay out of pocket for your care. Original Medicare also doesn’t cover foreign treatment, but you can purchase emergency plans that cover emergency care in foreign countries.

What Is the Downside to Medicare Advantage Plans?

There’s no shortage of reasons people avoid Medicare Advantage. It’s essential to understand these so you can avoid making the wrong decision. Listed below are some of the most notable.

Higher Out-of-Pocket Costs

As you can infer from the above info, Medicare Advantage plans are often costly. Always ask “What is the maximum out-of-pocket cost” before choosing a plan so you aren’t caught off guard. These costs can add up if you require multiple treatments within the same year.

Aggressive Marketing

Medicare Advantage salespeople are notorious for their aggressive marketing tactics. They often use pushy advertising strategies that make people uncomfortable. In some cases, Medicare ads are created to seem like they’re coming from the government.

Many people find Medicare ads to be misleading as well. Plans often advertise $0 premiums, but they aren’t free. Issues like these are why it can be so frustrating to navigate Medicare Advantage advertising and find a suitable plan.

Annually Changing Plans

Medicare Advantage plans change each year, causing details like networks, availability, and benefits to fluctuate. To clarify, imagine you enroll in a plan that accommodates all your current medical needs.

A reputable local care provider is in your network, and there’s no issue filling your prescriptions. One day, this all changes and you can no longer get the care you require. Situations like these can be difficult or even impossible to overcome.

Rigid Authorization Requirements

It’s not uncommon for people to have trouble getting their plans authorized. This can negatively affect their ability to get the right treatment. In some situations, your plan’s authorization could be denied and you won’t be able to get the coverage you desire.

Finding an Insurance Provider

Not all insurance providers are created equally, and it’s essential to do your due diligence before making a decision. See what other people online have to say about the results they got.

Were they satisfied overall? Did they encounter issues the provider couldn’t help them overcome?

The answers to questions like these will help ensure you make the right choice. Look into their pricing structure, as well. Many providers offer inflated rates that are difficult to accommodate, without providing extra benefits.

You can often save a substantial amount of money by shopping around. However, keep in mind that the cheapest options often offer minimal coverage. You may not get what you need from your insurance plan even though you pay your monthly premium.

Somewhere in the middle of the industry’s price range can help you meet your needs without stretching your budget.

What is their customer support like? Their support team should be easy to get in touch with and enthusiastic about helping you reach your goals. Otherwise, you’ll have difficulty overcoming issues on your own.

The Connection Between Social Security and Medicare

You may or may not know you are eligible to apply for and receive Social Security if you’re 62 or older and if you’ve worked and paid Social Security taxes for 10 years or more. Additionally, social security benefits are directly connected to Medicare benefits.

We are happy to explain how this all works. We will help you understand the benefits you’re  entitled to and assist you in making the best choices to benefit you and your family.

Need this assistance in Spanish? We have expert, bilingual guidance available. Our goal is to make you feel comfortable, covered and confident.

Get Started ASAP

As soon as you have the opportunity to secure the right plans, it’s essential to do so as soon as possible. This will help you make the right choice for your needs. Just be sure to understand the downside to Medicare Advantage plans.

Do you need help comparing Medicare Advantage Plans? Our professional staff offers expert, bilingual guidance to help make the best choice for your needs. Let’s make sure you get the insurance coverage that you deserve!