Medicare Advantage: Pros and Cons

Wondering if Medicare Advantage is right for you? Find out what is good (and bad) about MA.

by Amy De Vore+ on Jun 04, 2015 | 29 Comments

Like most everything in life there are both pros and cons to Medicare Advantage (also known as Medicare Part C or “MA” for short).  Finding the right Medicare insurance can be rather confusing for seniors - especially when parsing through the 150-page “Medicare and You” booklet that the government sends out as you approach age 65.  We have made a list of the advantages and disadvantages of choosing a MA plan that should help you understand if this product is right for you.

This article was updated on 6/4/15

What is Medicare Advantage?

Let’s start with the basics. Medicare Advantage is the name of a group of insurance plans offered by private companies that “replace” Original Medicare.  This means that if you go with Medicare Advantage, all the services traditionally covered by Medicare Part A and B will now be covered under your MA plan.*  MA benefits may be slightly differently than those offered under Original Medicare , but they must offer equivalent benefits by law.  If you are new to MA and want to learn more about how it works, check out our Medicare Advantage Overview page. Everyone else, check out our Pros and Cons list below.

*Everything except for hospice care -that is still covered by Original Medicare.

Medicare Advantage Pros and Cons

MA Plan Pros MA Plan Cons
Out-of-pocket maximum is $6700 a year Still requires you to pay copays and coinsurance fees
Many plans cost $0 a month Plans are difficult to compare since no two MA plans are alike
Usually includes drug coverage Usually no nationwide coverage
Many include hearing and dental Mainly HMO plans that require referrals to see specialist
Can include gym discounts Plan can change drug and medical coverage each year
Can switch to another MA plan during open enrollment Hard to switch to plans like Medigap


How Much Does MA Cost?  <---click here to find out

Bottom Line for Medicare Advantage

It’s very affordable, usually includes Rx coverage and caps your total annual risk at $6,700.  Just know that you will be limited to a smaller network and you will still usually have to pay deductible and copay fees that can add up (but not past the max $6,700 a year).

Other Options for Medicare Enrollees

Most people consider the following 3 options below when researching their senior health coverage.

1) Original Medicare
2) Medicare Advantage
3) Original Medicare + Medigap

Since Medicare Advantage has an out-of-pocket maximum, offers equivalent benefits to Medicare, and often includes drug coverage, MA usually provides more protection than Original Medicare. If you want more medical fee coverage, you will want to consider Medigap.

Medigap works very differently than MA. Medigap plans complement Original Medicare and can cover all Original Medicare’s deductibles, copays, coinsurance, and still offer additional coverage.  Make sure you check out our Medigap Overview page or read: Medigap Pros and Cons, to see if that is something you are interested in.

For further questions call 800-930-7956 or click here to get an Instant Medicare Advantage quote Print Friendly Version

Reader Comments and Questions

(Click here to leave a comment)

By John on February 09, 2019

CarePlus (Humana) offers a Medicare Advantage Plan for Central Florida residents and just received a 5 star government rating for 2019. My wife and I will be enrolling in Medicare shortly as we will both be turning 65 in July and, as of now, we are both in excellent health. Is an MA provider with a 5 star rating a sound choice for us or should we be be doing more research on Medicare Supplement Plans?

John,
Selecting a 5 Star Medicare Advantage is usually a good choice but remember to ensure that it includes your current doctors and RX drug requirements.

While Medicare Supplement (Medigap) plans cost more, they usually have a much larger network of doctors and small out-of-pocket expenses. If you rule out Medigap now, you would most likely have to go through medical underwriting to switch to it in the future.

Call us to discuss more: Since we are licensed and appointed to sell both types of plans, we can help you go over your options and best possible choices.

We also recommend you to check our Plan Recommendation Engine , which will ask a few key questions to see what type of coverage would work best for you.

-Eric from Senior65.com


By Carolyn on November 25, 2018

My solution to the Medicare choice problem has been solved. I am enrolled in a Medigap plan K, which has an out of pocket amount. It pays 50% of what Medicare doesn't pay. Also, there is a Medigap plan L that pays 75% of what Medicare doesn't pay with an out of pocket limit. For me, this is a no-brainer when comparing it to a Medicare Advantage plan. You get to choose your own doctors and have no network.


By Carol on November 22, 2018

Before I turned 65 I researched Medicare supplements so I would not have to worry about out of pocket medical costs. I am a type 1 diabetic using an insulin pump and CGM. I am currently enrolled in Medigap G but have recently looked into Medicare Complete, which is the MA. I am trying to understand all of this and do what is best for me financially and medically. If I enroll in Medicare Complete, I can assume there is a very good chance I will not be able to go back to the Plan G if I decide to do so next year. There is a $146 monthly premium for the Plan G I am paying now through AARP and the Medicare Complete I am looking at is $0 per month. With the Medicare Complete I will be responsible for 20% of durable medical supplies, which I am not liable for with Plan G.


By Michael on November 11, 2018

I am enrolled in HumanaChoice (PPO) Medicare Advantage Part D Since Jan 1,2004-Current however my plan was reinstated November 1, 2018 because I changed from Care Improvement Plus I was enrolled in that from March 1,2017-October 31, 2018 for the same reason no providers and the insurance was taking advantage of me regarding my premiums since Jan 1,2018 I am glad I dropped United Healthcare and went back to HumanaChoice (PPO) H5216-043-001


By John on November 09, 2018

I'm considering switching to a Medicare Advantage plan next year. I'm scheduled to have major foot reconstruction surgery that will require a night in the hospital. Under my current Medicare Supplement plan I would have no out of pocket expense. How can I find out what the typical out of pocket expense is for orthopedic surgery that requires an overnight in the hospital?

John,
The price for an orthopedic surgery with a night in the hospital varies greatly by each Medicare Advantage provider. This is where a licensed agent comes in. They can help you select a plan and estimate what certain procedures will cost. Hint: Senior65.com is run by licensed independent agents so if you are not already working with an agent, please give us a call.
-Michelle from Senior65.com


By Jess on August 21, 2018

My mother wants to get a second opinion at MD Anderson. She has been diagnosed with Lung Cancer. Early stages. She has Peoples Health Choice65 #14 HMO. Everything I am reading tells me her insurance WIIL NOT COVER this. Is this correct? Why is she limited when diagnosed with a life-threatening disease. The doctors in our area do not have the best reputation and she deserves to be able to get a second opinion and not limited in this very serious situation. Tell me what she can do to get authorization to seek better care and how can get this covered. If this does not happen I can promise my reviews will not be positive for your company.

Jess,
Sorry to hear about your mother's recent diagnoses. We would like to clarify that WE ARE NOT People's Health Choice65 and we are not appointed to sell their plan. We are unfamiliar with that insurance provider as we typically only work with and are appointed with national insurance providers.

We suggest that you contact People's Health Choice65 directly to clarify coverage and how best to get a second opinion and better care.

One thing to keep in mind. If you are not satisfied with your mom's current MA plan, Medicare Advantage's open enrollment starts on Oct 15th. Your mom will be able to apply to switch from her current plan to any other plan offered in your area regardless of her health history. So if People's Health Choice is not meeting your mother's needs, let them know you may take your business elsewhere.
Best of luck,
-Chris from Senior65.com.


By donna on November 07, 2017

my husband is retired and on original medicare now with retiree healthcare from previous employer that picks up part of what original medicare does not pay , however, he is losing his employer retiree healthcare. they will pay some on another medicare plan. He has cancer and all doctors are on medicare advantage plans we we are offered. however I have heard some bad things about it and wonder if we should go with one of the supplement plans.

Donna,
Sorry to hear that your husband is dealing Your question is specific and goes beyond what can be covered in a quick response. We can help you weigh the pros and cons of selecting a Medicare Advantage plan over Medigap when fighting cancer. That is one of the benefits of working with an agent and the best news is that there is no charge to you! If you are not already working with a health insurance agent, give us a call and we would be glad to help you.
-Michelle from Senior65


By Taylor Hicken on April 19, 2017

I haven't heard about Medigap before, but I wonder if my husband has. We've been planning on looking into medicare, but it we haven't been able to read through all the paperwork. I'm hoping that I'll have time within the next few days to take a look at it all, that way my husband and I can decide soon.


By Paula Freston on December 17, 2016

Can a Medicare Advantage plan be transferred to a different geographic location if it becomes necessary to move (e.g., to another state)?

Paula,
You will need to enroll in a new Medicare Advantage plan when you move. If you need help enrolling in a new Medicare Advantage plan, please call Senior65 licensed independent insurance agents at 800-930-7956.
-Chris from https://www.senior65.com/


By Richard P. Fehr on November 28, 2016

what are the pro and cons of switching from one Medicare Advantage plan to another?

Richard,
There are a few questions you will want to find the answers to before choosing/switching your Medicare Advantage plan:
  • Which plan covers your drugs at the most reasonable price?
  • Which plan works with your doctors and hospitals?
  • Which plan has the lowest out of pocket max?
  • Which plan cover extras like dental, vision, and/or hearing?
For further help deciding between Medicare Advantage plans call one of our Senior65 licensed independent insurance agents at 800-930-7956.
-Michelle from https://www.senior65.com/


By Flor varela on November 20, 2016

I'm 68 years old. I stared my Medicare part A. at 65 and part B. at 67 years old, when I dropped my insurance through my work company. I didn't know that I have and additional one And then it was too late to enroll in one. I have to wait until October I will like to have a supplemental or medic gap. P:S I Forgot to apply for prescriptions drugs. I really don't want to enroll on Medicare advantage insurance


By David McKay on September 07, 2016

My understanding if I originally enroll in a advantage plan and years down the road decide to enroll In traditional Medicare there is no guarantee that I will be accepted in a medgap policy due to age or health condition , is this something to consider when first signing up for either original Medicare or advantage plan ?

David,
You are correct, in most states, if you have certain health conditions it can stop you from being accepted into a Medigap plan (age should not be factor -unless you're younger than 65). You should definitely consider this when you first Medicare eligible, and choosing between Medicare Advantage and Medigap. If you need help with your initial decision or need help finding the right Medicare Supplement company to switch to, call one of our Senior65 licensed independent insurance agents at 800-930-7956.
-Chris from https://www.senior65.com/


By Mary Lloyd on August 30, 2016

I have been offered Medicare advantage(ppo) plan through my employer. after reading some horror stories about people being denied by their MA in nursing homes because someone who has never met them or has never treated them,decided they didn't need to be in the nursing home.I have just about decided not to take the offer. But on the chance I might be wrong about this company I would like to know what you think. I am currently on regular Medicare(primary) and have a supplement from the trust as secondary. Would it be wise to take the Medicare advantage or stick with what I have? Thank you Mary Lloyd

Mary,
Without knowing the specific details of the two plans offered to you, we wouldn't be able to offer advice.

When you retire, and you're ready to enroll in a non-job-based Medigap (Medicare Supplement) or Medicare Advantage, our Senior65 licensed independent insurance agents will be able to enroll you. Call 800-930-7956 to speak to one our agents for a quote or to purchase a plan.
-Eric from https://www.senior65.com/


By Jay on February 20, 2016

This system of Medicare Plan and supporting to Advantage plan very Horrible and Scary If You have Mini Stroke ( warning to Major Stroke) After going thru processing of Claim and Denial of claim and HUGE Medical Bill of Hospital YOU may Have FATAL Attack This SYSTEM of Health care / Medicare ? Insurance Plan / Hospital very Horrible God BLESS


By Patty on February 04, 2016

My sister is having a lot of problems and is finding it impossible to get a diagnosis of her many symptoms. Under her plan, ,she is limited to one sub-standard hospital that her primary doctor is affiliated with. We want to take her to Loma Linda for diagnostic consultation, which is out of the network and do not know how to go about this. Locally she must be able to go to the better hospital but would have to change her network that allows this.How does she go about that since the enrollment period is over. (she is low income and is "extra help" with medicines and gets help with her medicare premium.)

Patty,
Medicare Advantage HMO plans not only have small networks, but you are in a group that has an even smaller network .You will need to contact your provider to see if you can switch groups within your plan, and learn which hospitals are in that group. If this still doesn't work for you, another option is to switch to a 5-star Medicare Advantage plan (you do not need to wait until Open Enrollment, you can do this at anytime of the year) -as long as this plan works within your Extra Help system. Please call a licensed independent insurance agent at 800-930-7956 for further help.
-Amy from https://www.senior65.com/


By Marianne Helm on December 02, 2015

Does anyone even consider how much this Micare Advantage plan actually pays the doctor? How long before medical practices are going to be 'closed to medicare advantage pplans' or have members be placed on a waiting list/ Doctors cannot operate their practices on pennies. Sorry, I'm staying with regular medicare and am paying for a secondary supplement plan.


By Fred Levers on November 19, 2015

Is the medicare advantage plan for Nevada different in any way?

Fred,
Medicare Advantage plans are not standardized, therefore, they differ not only from the state and zip code you live in, but they can differ from company to company, and can have variances within the company -by offering more than one plan. Please give us a call at 800-930-7956, and we'd be happy to help you find a Medicare Advantage plan for Nevada.
-Chris from https://www.senior65.com/


By Jim D on November 07, 2015

My primary residence in OH but I own property in OH and FL. I am a snowbird and live in FL 4-5 months each year. With a MA-PPO plan, I know I can receive Urgent/Emergency care coverage when out of my network, but I don't know what costs would not be covered. Can you explain? Thanks!

Jim,
Thank you for your question. With any health plan, including HMOs, you can seek emergency care in any state, and be treated as in network. However, if you are admitted into the hospital, you may be charged out of network with a Medicare Advantage PPO, and may have to pay 100% out of pocket for an HMO.

If you live in two states, it's recommended that you choose a PPO plan that offers nationwide coverage (they are rare to find). If that is not available, there may be other options for you. Please contact us at 800-930-7956 to help find a Medicare Advantage plan for you.
-Amy from https://www.senior65.com/


By jason oliver on October 30, 2015

I don't see this question come up, but isn't it extremely difficult to drop MA and try to get a medigap because they will find something in your past medical history and use it to refuse you. And it can be something as simple as having taken medication for depression. And then you are stuck forever with what you have even if you are not satisfied? This happened to someone I know and was told many have had the same problem including a surgeon who took a test drug many years before applying .

Jason,
You are 100% correct! It can be difficult to switch from Medicare Advantage to Medigap due to medical underwriting. Because of that reason, we suggest, you choose a Medicare insurance plan when you're first eligible based on your future care, not just your current health needs.
-Chris from https://www.senior65.com/


By Grace on October 13, 2015

Under what circumstances would the plan F Medigap insurance cause one to go bankrupt? What is the extent and types of drugs original medicare does and does not pay for in the case of cancer and it's treatment? How does that compare with Medicare Advantage plan coverage for the same circumstance?

Grace,
It would be highly unlikely if you were enrolled in a Medigap Plan F plan that you will have any out of pocket costs for medical care each year, let alone go bankrupt. Remember that the only way you pay for a medical service out of pocket is if Original Medicare doesn't cover it.

As for specific drugs that Medicare Part B and Part D cover, you'll want to contact us at 800-930-7956 with your list of drugs and we can give you a specific answer.

Medicare Advantage "replaces" Original Medicare, but it must cover the same services, albeit, MA plans can cover the services differently. To learn the specifics of how MA plans' drugs are covered you'll want to call the number above.
-Michelle from https://www.senior65.com/


By Lee on October 11, 2015

Is it true that with a medigap plan (I was told plan F is the 'best'), there is still no maximum out of pocket expense each year and you could go 'bankrupt' as someone here said, as opposed to a MA plan?

Lee,
Thank you for your question. You are correct that Plan F does not have an out of pocket maximum, BUT since Medigap fills in the gaps of Medicare, most Plan F clients will not have any out of pocket health expenses. However, if there is something that Medicare does not cover and Medigap doesn't cover it, then you would have those out of pocket expenses. The same goes for Medicare Advantage -since the out of pocket limit does not cover out of network doctors (HMO plans) and it can have caps on hospitalization, Skilled Nursing care, and other services. Hope this helps!
-Amy from https://www.senior65.com/


By Jack Spaeth on October 10, 2015

Since Medicare Advantage Providers are "For Profit" I'm concerned that proper treatment may be sacrificed for the almighty dollar. Do you have any information on that?

Jack,
We understand your concern due to the nature of Medicare Advantage plans having small, local networks,and generally run as an HMO. Our suggestion is when getting quotes, also look at the PPO Medicare Advantage plan options, even if they are more expensive, and compare how they cover services. As well as, Medicare has a rating system for MA plans based on many factors, including customer satisfaction. Hope this helps!
-Michelle from https://www.senior65.com/


By Barbara O'Neill on September 29, 2015

Another negative (I have been told) with Medicare Advantage is that even though there are out-of-network options, many of the best hospitals, doctors, etc. will not accept MA plans , period. So, if you are seriously ill and want to go to the Mayo Clinic or MD Anderson etc, you will not have the option to use their facility unless you can pay the full cost out of pocket. Since we are currently in MA plan, I am trying to confirm this information.

Barbara,
If your Medicare Advantage plan is an HMO, then you will not have the option of out of network providers and hospitals. There are some PPO plans available that will give you this option. If you're concerned about network, you may want to consider Medigap plans that offer nationwide coverage (the same network of doctors and hospitals as Original Medicare). Hope this helps!
-Amy from https://www.senior65.com/


By Cathie Best on September 03, 2015

In referring to the advantage of an MA having an out-of-pocket limit - what am I not knowing about out-of-pocket expenses for Medicare? My husband is covered with a medigap plan and we have the expense of that premium and a super low premium to include dental coverage, but otherwise we pay nothing but a very small deductible at the beginning of the year. What possible out=of=pocket costs do we need to be considering with this traditional coverage while we are considering an MA?

Cathie,
If you have Original Medicare and Medigap Plan C or F, most of our clients find, they have no out of pocket expenses besides their premium for health care. If you asking what are the out of pocket costs for Original Medicare without a Medigap plan, then it would be the deductibles, copays, and coinsurance, and Medicare does not put a cap on how much you would spend for these each year. Hope this helps!
-Amy from https://www.senior65.com/


By WittnWisdom on August 13, 2015

I just read another article that says that Medicare Advantage is simple because you don't have the alphabet soup of Medigap choices. Which do you think is easier to understand: Medigap or Part C? So far I'm confused about which Medicare Advantage plans is right for me.


By Ricardo Cantu on July 27, 2015

With many chronic illnesses, is traditional Medicare better in the long run over an MA plan?

Ricardo,
Good question. Here are two things to consider: 1) If you are able to afford a Medigap/Original Medicare combo, they might be a good option, 2) If you are not able to afford Medigap, a Medicare Advantage plan is a good option for chronic illnesses because it has a max out of pocket (unlike Original Medicare which does NOT have a max out of pocket). Please call us at 800-930-7956 to help you figure out which is the right option for you.
-Michelle from https://www.senior65.com/


By Samantha D on June 10, 2015

Isn't Medicare Advantage going to change (or stop) under Obamacare.

Great Question Sam,
Many people were worried that MA would change dramatically because of new Obama Care rules. So far we haven't seen many changes across the board. According to Diane Omdahl, president of 65 Incorporated, an educational and consulting firm not tied to the government or providers, "Some MA plans are restricting or eliminating coverage for out-of-network expenses or are cutting back on supplemental services. In addition, some MA and Part D plans may be cutting back on reimbursements for certain prescription drugs by changing their tier or payment classification." So it really depends on the plan you chose. If you need help selecting a plan, give us a call.
-Chris from https://www.senior65.com


By Andrew Manley on June 09, 2015

What would you say is the biggest negative about enrolling in a Medicare Advantage plan?

Andrew,
This is an excellent question. I would probably say the biggest negative of choosing a Medicare Advantage plan is the small network of doctors and hospitals. I'd be curious to hear what other people find to be their greatest pro and con for Medicare Advantage.
-Amy from https://www.senior65.com/


By Martin Basos on May 07, 2015

This is very helpful. You include the major PRO. Medicare Advantage, unlike plain old medicare, has a maximum out of pocket each year. This means if you have a major issue you won't go bankrupt on MA where you might on just medicare.



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