Top 5 Disadvantages of Medicare Advantage Plans (+ 5 Benefits)
The biggest disadvantage of Medicare Advantage is that you have fewer doctors to choose from when you get medical care.
Plans can also cost more overall than Original Medicare if you have complex medical needs. Medicare Advantage plans are best if you don't need expensive treatments or tests. But Medicare Advantage plans do have some perks, including simplified coverage and a yearly cap on health care expenses.
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Pros & cons of Medicare Advantage
Advantages
Five disadvantages of Medicare Advantage plans
Medicare Advantage plans could be a bad choice if you want complete flexibility to choose your doctor.
The plans use provider networks, which put some limits on where you can get medical care. It can also be hard to figure out your medical costs since the amount you have to pay yourself can change based on the plan and the type of care you need. That's because the plans have different deductibles, copays and coinsurance levels.
Several large companies, including Aetna, Centene (Wellcare) and Humana are cutting back on Medicare Advantage plans for 2025. This means the companies may offer fewer benefits or sell plans in fewer areas, or both.
This could make it harder to find a Medicare Advantage plan in 2025, depending on where you live. If you already had a Medicare Advantage plan from one of these companies, you may have to switch plans or switch back to Original Medicare for 2025. If you can keep your plan, you should review your coverage to make sure it still aligns with your needs.
Can't use Medicare Advantage everywhere
Medicare Advantage plans limit the doctors and hospitals that you can use.
With some plans, you don't have any coverage if you use a doctor that isn't in the network. With others, you still have coverage, but you pay more than if you had used an in-network doctor. Some plans also require you to get a referral to see a specialist, which can slow down your treatment.
In contrast, Original Medicare lets you go to any doctor that accepts Medicare. And most medical offices do. More than 90% of primary care doctors in the U.S. take Medicare. That means you can choose almost any doctor you want and still be covered.
About 22% of people who left their Medicare Advantage plans in 2024 said it was because of problems with the plan covering doctors and hospitals. Before you buy a Medicare Advantage plan, make sure the doctors and hospitals you want to use are in the network.
Higher costs if you have serious medical needs
Medicare Advantage plans can be more expensive if you need a lot of medical care or complex medical care.
If you need expensive medical care, you could end up paying a large amount out of pocket, even with the annual cap on your share of the bills. In this case, it's usually better to stick with Original Medicare and add a Medicare Supplement plan to pay more of your health care bills.
Example: Medicare Advantage vs. Original Medicare for a hospital stay
Say you have Original Medicare. If you have to stay in the hospital, you pay $1,676 for the Medicare Part A deductible. But after that, there are no more daily costs until you've been in the hospital for 60 days.
But if you have a Medicare Advantage plan, you'll almost always pay for some of the costs even after your deductible. You'll probably have to pay a set amount each day, called a daily copay, as soon as you are admitted.
For example, even if your plan has no deductible, you still have to pay a set amount, called a copay, for each day you're in the hospital. If you have a $300 daily copay, it would only take six days for your hospital stay to cost more than it would with Original Medicare. Your coverage and how much you pay depend on your plan's deductible and copay levels, and how long you're in the hospital.
Preauthorization and coverage approval
You might have to get prior approval from your Medicare Advantage plan for some types of medical care.
Medicare Advantage plans have to follow strict rules about preauthorization, and the process can make getting care slower and more difficult. Original Medicare does not have any preauthorization requirements for medical care.
More than 16% of people who left their Medicare Advantage plans in 2024 said it was because of problems getting their plan to pay for medical care. If you have a medical condition, make sure you choose a Medicare Advantage plan that covers the type of health care you need.
Covered doctors may change
Medicare Advantage plans can change what medical offices you're allowed to use.
You might find a doctor you like, only to have to find a new doctor the next year. In contrast, many more providers accept Original Medicare, and options with it tend to be more stable.
You might get stuck in your plan
If you buy a Medicare Advantage plan, you might not be able to get better coverage if your health declines.
That's because you may have missed the window to get the best rates on Medicare Supplement plans, which cover more of your medical bills than Medicare Advantage.
You might be generally healthy when you turn 65, and a Medicare Advantage plan might seem like a good option. But if your health declines and you need better coverage, you'll have much higher rates for a Medicare Supplement plan, if you can get one at all. But if you skip Medicare Advantage and sign up for Medicare Supplement when you're first eligible, your rates are locked in, even if you have medical problems.
Is Medicare Advantage good?
Medicare Advantage plans can be a good choice if you want simplified coverage and extra perks.
Plans usually have low monthly fees. Plus, you'll have a yearly cap on how much you could pay for medical care. This can help you save money if you end up having an expensive health event.
Low or no monthly rates
Medicare Advantage plans often charge little or nothing in monthly premiums.
The average cost for a Medicare Advantage plan is $28 per month, but rates change depending on the company, the plan's benefits and your location.
Most people have access to a plan with no monthly cost. Just make sure to review the specifics of a plan, even if it doesn't have a monthly fee. It might make sense to pay more for a plan if it gives you better coverage.
You still have to pay for Medicare Part B, which is $185 per month in 2025. Some Medicare Advantage plans have the perk of paying for part or all of your Part B rate.
Medicare Advantage plans are not always cheaper or a better deal than Original Medicare. Original Medicare is made up of Medicare Parts A and B. If you have complex health care needs, for example, it's usually better to pair Original Medicare with a Medicare Supplement plan (also called a Medigap plan).
This might cost more each month, but it usually means you'll pay less for your health care overall. Medicare Advantage plans, on the other hand, are usually a good choice if you have more routine health care needs and don't need complex or expensive treatments.
Bundled coverage
Medicare Advantage plans are simple, serving as "all-in-one" alternatives to Original Medicare.
Medicare Advantage plans bundle Medicare Part A and Medicare Part B, which cover inpatient and outpatient medical care. They also usually include Part D prescription drug coverage.
In contrast, having Original Medicare means buying coverage separately, which can mean more moving parts to keep track of. You can choose the coverage you want, but you'll also have separate monthly fees. For example, you can choose Part A, Part B, Part D drug coverage and a Medigap plan, which helps fill in coverage gaps left by Parts A and B. You'll have separate monthly rates for each part, although most people don't pay for Medicare Part A.
Extra perks
Medicare Advantage plans provide extra coverage that's not available with traditional Medicare.
These perks can include vision, hearing and dental services, gym memberships, preventive chiropractic care and allowances for over-the-counter supplements. Each plan offers its own unique set of perks, so be sure to review the extra coverage carefully if you want a specific benefit.
Cap on how much you'll pay for health care
Unlike Original Medicare, Medicare Advantage plans have out-of-pocket limits that cap the total amount you pay for health care.
If you use in-network doctors, you won't pay more than $9,350 per year toward medical bills. But if you have Original Medicare, which means just Parts A and B, you won't have a cap on your medical spending. That means you could end up paying for a lot of your health care costs, unless you buy a Medigap plan to supplement your coverage.
Some Medicare Advantage plans let you use doctors that aren't in the network, but you'll pay more for medical care.
Variety of plans to choose from
Most people have an average of 23 Medicare Advantage plans to choose from in 2025.
That means you can shop around and find a company and plan that you like and that fits your budget. Depending on where you live, you may have only one plan available or you could have up to 73.
Each plan has its own unique set of coverage perks. For example, you might choose a plan that has good coverage for hearing care, including paying for hearing tests and hearing aids, which isn't something that Original Medicare covers. Or you might want a plan that has good fitness benefits, like a free gym membership or access to home workouts. The variety of plans lets you find one that fits your needs.
Is a Medicare Advantage plan the best choice for you?
If you want to simplify your Medicare coverage and you don't mind using in-network doctors, a Medicare Advantage plan could be a good choice.
Medicare Advantage plans are usually a good choice if you're generally healthy and don't need much health care. It's helpful to get several quotes to find the best Medicare Advantage plan for your situation. Compare the monthly rate, coverage, extra perks and customer satisfaction reviews for each company.
But if you have complex health care needs, it's usually better to have Original Medicare and a Medicare Supplement plan than Medicare Advantage.
That combination typically covers more of your medical bills than a Medicare Advantage plan. Plan G is usually the best Medicare Supplement plan if you are just getting Medicare coverage. If you take prescription drugs or think you might in the future, consider a Medicare Part D plan, too.
Medicare Advantage vs. Original Medicare
Medicare Advantage plans are becoming more popular. About 61 million people can get Medicare, and 54% have a Medicare Advantage plan. That's up from 19% in 2007.
Original Medicare pays for about 80% of your medical costs, but there's no yearly limit on the amount you pay. Medicare Advantage plans have a yearly cap, which limits how much you could pay if something big happens.
Medicare Advantage (Part C) | Original Medicare (Parts A and B) | |
|---|---|---|
| Coverage | Includes Parts A, B and usually D | Separate plans for Parts A and B |
| Drug coverage | Usually included | Not included but can be added |
| Added benefits | Often includes vision, hearing and dental services, gym memberships and other perks | None |
| Monthly rate | Usually low, but Part B is paid separately | Most people do not pay for Part A Part B: $185 per month Part D drug plans vary in price |
| Provider networks | Require you to go to certain doctors | Can use any medical office that accepts Medicare |
| Costs | Deductibles, copays and coinsurance levels vary by plan. | Covers 80% of your medical bills. Deductibles, copays and coinsurance levels are set by the government. |
How Medicare Advantage works and how it affects you
With Medicare Advantage, plans and medical offices are usually paid a sum of money up front to manage patient care. This gives them an incentive to keep patients healthy and out of the hospital.
If patients stay healthy, the plans and medical providers come in under budget and make money. If patients get sick and require hospitalization, the plans go over budget and lose money.
Critics of Medicare Advantage plans say this structure encourages providers and health plans to skimp on health care. For example, a plan could refuse to pay for certain health screenings or a nursing home stay to save money.
There are five main types of Medicare Advantage plans. Health maintenance organizations (HMOs) and preferred provider organizations (PPOs) are the most common.
- Health maintenance organizations (HMOs): These plans require you to use in-network doctors except in emergencies. You also must have a primary care doctor and get a referral to see a specialist.
- Preferred provider organizations (PPOs): You can use any doctor you want with a PPO, but you will pay more for out-of-network care. You don't need a referral to see a specialist and don't have to have a primary care doctor.
- Private Fee-for-Service (PFFS) plans: Like PPOs, these plans have in-network doctors, but you can go outside of the network for a higher cost. The rates for each type of medical service are set by the plan, and out-of-network doctors can choose to either accept or deny care based on how much each service costs. PFFS plans are usually expensive.
- Special Needs Plans (SNPs): These plans tailor coverage to certain groups, like those with chronic conditions or those who dual-qualify for Medicare and Medicaid. SNPs usually use HMO or PPO networks.
- Medical Savings Account (MSA) plans: These plans have high deductibles and come with a medical savings account to help you pay health care costs. They aren't a good choice if you need a lot of medical care. The high deductible will mean you have to pay a lot of your bills yourself.
The plan types available to you depend on where you live and what companies sell plans in your area.
Medicare Advantage vs. Medicare Supplement
Medicare Advantage and Medicare Supplement plans are both sold by private insurance companies.
Medicare Advantage is a stand-alone plan that includes all your Medicare coverage. Medicare Supplement plans, also called Medigap plans, are add-on plans that you stack on top of Original Medicare. A Medigap plan helps cover some of the costs that Original Medicare doesn't.
Medicare Advantage | Medicare Supplement | |
|---|---|---|
| Coverage | Includes Parts A, B and usually D | Extra coverage fills in gaps left by Original Medicare. Drug coverage is not included. |
| Out-of-pocket costs | Usually low monthly rates. Often, higher deductibles, copays and coinsurance. | Higher monthly rates but lower costs for medical care. |
| Provider networks | Yes, with most plans. | No. You can use any medical office that accepts Medicare. |
| Foreign travel | Depends on the plan. | Some plans cover foreign travel health expenses. |
Medicare Advantage and employer health insurance
You can have both Medicare and health insurance through your job at the same time. The size of your employer determines which plan pays first.
Medicare is the primary coverage if your employer has fewer than 20 employees. This means that Medicare gets your medical bills first and pays its share. Then, your employee health insurance plan will pay for anything that it covers but wasn't already paid for by Medicare. If your employer has 20 or more workers, your employee plan is primary, and Medicare Advantage pays next.
If you work for a small company and qualify for Medicare, you should enroll in Medicare Parts A and B. If you don’t, your employee plan could deny coverage. There is a law that prevents large employers from requiring eligible workers to sign up for Medicare. The law doesn't apply to small businesses, which means a smaller employer could require you to sign up for Medicare if you qualify.
A Medicare Advantage plan will probably have a lower monthly rate than a plan from your job. The coverage for Medicare Advantage plans and plans from employers varies. Make sure you look at the options and understand what is covered before you choose a plan.
Frequently asked questions
What is the downside of a Medicare Advantage plan?
The biggest disadvantage of Medicare Advantage plans is that they limit your choice of doctors and medical offices. If you have complex or expensive medical needs, you might also pay more for your health care with a Medicare Advantage plan versus Original Medicare and a Medigap plan.
Why are people leaving Medicare Advantage plans?
About 22% of people who leave Medicare Advantage plans do so because they have problems finding doctors and hospitals that take their plan, according to survey data from the Centers for Medicare &
Why do doctors not like Medicare Advantage plans?
Doctors and hospitals say they have issues with Medicare Advantage plans taking a long time to pay for medical care or refusing to pay for something. This causes some doctors and hospitals to stop taking Medicare Advantage plans, which can make it harder to find medical care.
Methodology and sources
Medicare Advantage rate data for 2025 comes from public use files (PUFs) from the Centers for Medicare & Medicaid Services (CMS).
Rates are for Medicare Advantage plans that include prescription drug coverage. Employer-sponsored plans, health care prepayment plans (HCPPs), Medicare-Medicaid Plans (MMPs), Program of All-Inclusive Care for the Elderly (PACE) plans, sanctioned plans and Special Needs Plans (SNPs) are not included in the rates.
Disenrollment data is also from CMS and references a survey of people who voluntarily left their Medicare Advantage plan in 2024. Other sources for this article include the Center for Medicare Advocacy, KFF and Medicare.gov.
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Callers will be directed to a licensed and certified representative of Medicare Supplement insurance and/or Medicare Advantage HMO, HMO SNP, PPO, PPO SNP and PFFS organizations. Calls will be routed to a licensed insurance agent who can provide you with further information about the insurance plans offered by one or more nationally recognized insurance companies. Each of the organizations they represent has a Medicare contract. Enrollment in any plan depends on contract renewal.
Availability of benefits and plans varies by carrier and location and may be limited to certain times of the year, unless you qualify for a Special Enrollment Period. We do not offer every plan available in your area. Currently we represent 73 organizations that offer 5,110 products in your area. Contact Medicare.gov or 1-800-MEDICARE, or your local State Health Insurance Program (SHIP), to get information on all of your options.
These numbers provided are not specific to your area, but rather represent the number of organizations and the number of products available on a national basis. We will connect you with licensed insurance agents who can provide information about the number of organizations they represent and the number of products they offer in your service area. Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Medicare has neither reviewed nor endorsed the information contained on this website.
Medicare supplement insurance is available to people age 65 or older enrolled in Medicare Parts A and B, and in some states to those under age 65 eligible for Medicare due to disability or end stage renal disease.
Medicare Advantage and Part D plans and benefits are offered by these carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Anthem Blue Cross, Aspire Health Plan, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, GlobalHealth, Health Care Service Corporation, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Baylor Scott & White Health Plan, Simply, UnitedHealthcare, Wellcare and WellPoint.
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