Key points
-
A Medicare Advantage plan may offer more comprehensive coverage than original Medicare.
-
You may also benefit from having your own spending limit.
-
Despite these benefits, there are some serious drawbacks to a Medicare Advantage plan to be aware of.
-
The $23,760 Social Security bonus most retirees completely overlook ›
Medicare’s open enrollment period has been going on for more than a month now. And right now, you only have a few more weeks to change your health insurance for 2026.
One option you might consider is switching from Original Medicare to a Medicare Advantage plan. Switching to Medicare Advantage can have benefits, but it also has drawbacks. Here’s what you need to know if you’re considering joining Medicare Advantage for the first time.
Image source: Getty Images.
1. You can get more services
When you’re living off a fixed retirement income made up of savings and Social Security, it’s important to plan carefully for your health care expenses. Many retirees are surprised to learn that there are many basic health care services that Medicare does not cover, including dental cleanings, eye exams, and hearing aids.
One nice thing about Medicare Advantage plans is that they usually offer additional benefits beyond what original Medicare pays for. These benefits often include dental care, eye exams, and hearing aids. Some Medicare Advantage plans even offer fitness and nutrition benefits that can lead to significant savings.
2. You will have an annual limit on medical expenses
Another drawback of the original Medicare is that there is no cap on annual health care costs. Then again, when you’re no longer working and living off your Individual Retirement Account (IRA) and monthly Social Security checks, it can be difficult to manage.
Medicare Advantage plans, on the other hand to do have an annual health care spending limit. This can give you peace of mind if you tend to have large medical bills or if you tend to be tight on cash in retirement.
3. You may not save money over original Medicare
Some Medicare Advantage students find that their costs are lower compared to original Medicare, especially since many Advantage plans have a $0 monthly premium. But that doesn’t mean you guaranteed save money
As a member of Medicare Advantage, you may experience other costs, such as higher premiums and deductibles. You’ll need to do some careful math to see if Medicare Advantage really makes sense for your specific health and prescription needs.
4. You will only be in the network of a specific provider
One nice thing about Original Medicare is that it lets you see any provider in the country that accepts Medicare. With Medicare Advantage, you are usually limited to a specific network of health care providers, which usually depends on where you are.
This can be problematic for several reasons. First, it can mean you’re not seeing the doctors you want. Second, if you travel a lot or spend a lot of time in another part of the country, it may be difficult for you to get access to service providers.
When you leave a Medicare Advantage plan, you may face huge out-of-pocket expenses that limit your retirement savings. So, it needs to be carefully considered.
5. You may have to deal with obstacles
Very often, Medicare Advantage plans require prior authorization for various procedures and diagnostic exams. However, this can lead to delays in getting the care you need.
Getting pre-approved for tests and appointments can also be stressful. If you choose to use Original Medicare, you may have less trouble getting access to care.
It’s definitely worth exploring your Medicare Advantage plan options during fall enrollment. If you don’t do your research, you won’t know what’s out there. Just keep these general points in mind if you’re not very familiar with Medicare Advantage, as they may change your enrollment decision in 2026.
$23,760 The social security bonus is completely overlooked by most retirees
If you’re like most Americans, you’re a few years (or more) behind on your retirement savings. But a handful are little known “Secrets of Social Security” can help increase your retirement income.
One simple trick can pay you as much as $23,760 more… every year! When you learn how to maximize your Social Security benefits, we believe you can confidently retire in peace, as we all strive to do. Log in Stock advisor To learn more about these strategies.
Check out “Secrets of Social Security” »
The Motley Fool has a disclosure policy.
Thinking of switching to a Medicare Advantage plan during open enrollment? 5 things you need to know. originally published by The Motley Fool.