Medicare Advantage plans are heavily advertised. You’ve probably seen the TV commercials or gotten the oversized postcards in your mailbox. On the surface, they sound great: $0 premiums, extra benefits, one card for everything. But what most people don’t realize is these plans are built very differently from Original Medicare. And while the pitch is simple, the reality is more complicated—and sometimes expensive.
I’m not here to scare you. I just want you to know what you’re actually signing up for. Because a lot of people don’t fully understand how these plans work until they need serious care. By then, it’s often too late to switch. These are the problems with Medicare Advantage that I think everyone deserves to know before they enroll.
1. Medicare Advantage Plans Have Narrow Provider Networks
With Original Medicare, you can see any doctor in the country who accepts Medicare—no referrals, no networks, no surprises. Medicare Advantage plans work more like HMO or PPO insurance. You’re limited to a list of approved doctors, hospitals, and facilities that are under contract with your specific plan.
That sounds manageable until it’s not. You might find out your preferred specialist isn’t in network. Or that a top-rated hospital isn’t covered. I’ve seen people switch doctors multiple times in a year because their plan’s network changed. Some plans also require referrals to see specialists, which adds another layer of red tape.
It’s even trickier if you move or travel. If your Advantage plan doesn’t operate in the new area, you’ll either need to switch plans or risk being out of network entirely.
2. Prior Authorization is a Constant Frustration
This is one of the most common complaints I hear. Medicare Advantage plans require prior authorization for many services. That means your doctor has to get permission from the insurance company before you can get certain treatments, tests, or procedures.
It slows things down. Sometimes it’s just a few days. Other times it’s weeks. And sometimes the plan just says no.
For example, someone might need a rehab stay after surgery, or an MRI to diagnose an issue. With Original Medicare, those services typically go forward without interference. With Advantage, the plan might say, “We don’t think this is necessary,” and deny it outright.
This can be incredibly frustrating for both the patient and the doctor. And if you appeal the denial, that can take even more time—time you may not have if you’re sick or recovering.
3. Out-of-Pocket Costs Can Add Up Fast
People are drawn to Medicare Advantage because of the low—or even $0—monthly premium. But that’s just the starting cost. Advantage plans work on a pay-as-you-go model, meaning you’re responsible for copays and coinsurance for almost everything.
Here’s what that might look like:
- $40 to see a specialist
- $90 for an emergency room visit
- $350 per day for hospital stays
- 20% for chemotherapy or radiation
Most plans do have an annual maximum out-of-pocket limit, usually around $5,000 to $8,000. But that’s a ceiling—not a guarantee you won’t pay a lot along the way.
If your health is great and you rarely go to the doctor, you might come out ahead. But if you end up needing surgery, rehab, or treatment for a new diagnosis, you could hit your out-of-pocket max quickly. And if your plan’s network doesn’t include the provider you want, your out-of-pocket cost could be even higher—or not covered at all.
4. You’re Locked In Until Next Year (In Most Cases)
When you enroll in a Medicare Advantage plan, you’re typically locked into that plan for the rest of the calendar year unless you qualify for a special enrollment period. That might include moving to a new area, losing coverage, or other specific events—but not buyer’s remorse.
If you sign up and then realize your doctors aren’t in network, or you hate dealing with referrals, or you get hit with unexpected costs—you can’t just switch out mid-year. You have to wait for the Annual Enrollment Period (October 15 to December 7) and changes won’t take effect until January 1.
Worse yet, if you want to leave your Advantage plan and go back to Original Medicare with a Supplement, you may have to pass medical underwriting to get the Supplement. There’s no guarantee you’ll qualify—especially if your health has changed.
5. Benefits Can Change Every Year
Your plan might look good now, but Medicare Advantage plans reset every January. Insurance companies can:
- Drop doctors and hospitals from the network
- Change drug formularies
- Increase copays or out-of-pocket limits
- Cut or eliminate extra benefits like dental or vision
And they’re allowed to do all of this as long as they notify you in the Annual Notice of Change, which most people throw away or don’t read closely.
That means your plan in year two might look very different from what you signed up for. I’ve seen people forced to switch plans every year just to keep their doctor or avoid big jumps in cost. And every time you switch, you risk losing access to a medication, benefit, or provider.
6. Plans May Not Travel Well
Original Medicare works anywhere in the country. If a doctor takes Medicare, they take you. Medicare Advantage plans are local. Most coverage is only valid within a specific geographic region.
If you travel often, especially for long stretches, this can be a serious problem. Snowbirds, RVers, or people with adult children in other states often find themselves out of network when they need care. Some PPO plans offer limited out-of-area coverage, but HMOs typically do not.
Emergency care is usually covered anywhere—but that only helps if it’s a true emergency. If you need follow-up care, routine prescriptions, or therapy while out of town, you may have to fly home or pay out of pocket.
7. Some Plans Overpromise with “Extras”
Medicare Advantage plans love to advertise their extra benefits—free dental, vision, hearing, gym memberships, grocery cards, and more. And while these benefits do exist, the fine print is rarely explained up front.
Here’s what I see in real life:
- The dental coverage might only include basic cleanings and x-rays—not crowns or implants
- Vision benefits may be limited to one provider chain
- Hearing aids might come with a $1,500 copay
- “Free” gym memberships go unused by most people
- Grocery cards or over-the-counter allowances are often restrictive and hard to redeem
In short, these extras aren’t worthless—but they’re often not as generous as they sound. And if someone enrolls in a plan because of a gym benefit but loses access to their preferred doctor, they’ve traded something essential for something minor.
Final Thoughts
I help people with both Medicare Supplement and Medicare Advantage plans. I’m not anti-Advantage—but I am pro-transparency. These plans can work well for some folks, especially those who are healthy, on a budget, and willing to stay within a network.
But I’ve seen too many people blindsided by restrictions they didn’t know about, or disappointed by how little they actually saved in the long run.
If you’re trying to figure out what’s right for you, I can walk you through it. I’ll compare costs, explain the real tradeoffs, and help you think through what kind of coverage actually fits your life—not just what sounds good on a flyer.
If you’ve already enrolled and things aren’t working out, let’s talk about your options. Sometimes we can fix it. Sometimes we can plan better for next year.
Either way, you don’t have to guess your way through it. I’ve helped plenty of people with this exact decision. I can help you too.