What are disadvantages of Medicare?

Medicare's disadvantages often stem from its different parts, with Medicare Advantage (Part C) having network restrictions, referral needs, prior authorizations, and potential for mid-year benefit changes, while even Original Medicare (Parts A & B) leaves gaps like dental/vision, requiring supplemental plans (Medigap/Part D) that add premiums and costs, plus coverage limitations when traveling.

Is there a downside to Medicare?

Key Takeaways

Medicare Advantage offers extra benefits, but out-of-network care may be limited or costly. Other disadvantages include difficulty switching out of the plans later, restrictions on care access, and limitations on extra benefits.

What are the 5 things Medicare doesn't cover?

Medicare generally doesn't cover long-term care, most dental care, routine vision services (like glasses), hearing aids/fittings, and cosmetic surgery, though it does provide strong coverage for hospital and doctor services; you can often get coverage for these gaps through Medicare Advantage (Part C) or supplemental plans. 

Is it better to go on Medicare or stay on private insurance?

Neither Medicare nor private insurance is universally "better"; the best choice depends on individual needs, but Medicare often offers lower overall costs and simplicity for seniors, while private insurance excels in covering dependents and potentially offering more choice with networks/out-of-pocket caps, though at higher premiums. Medicare boasts lower admin costs and standardized coverage, but Original Medicare lacks an out-of-pocket maximum, a feature typically found in private plans and Medicare Advantage (Part C). 

What does Dave Ramsey say about Medicare?

Dave Ramsey's Medicare advice centers on planning ahead, understanding enrollment periods to avoid penalties, using Health Savings Accounts (HSAs) if possible, and supplementing Original Medicare with Medigap or Medicare Advantage (Part C) to cover gaps like dental, vision, and long-term care, stressing that mistakes can be costly and recommending expert advice for personalized choices. 

Top Disadvantages of Medicare Advantage Plans

At what point is full coverage not worth it?

Full coverage isn't worth it when your car's low value (e.g., less than 10x annual premium) doesn't justify the cost, you have savings to cover repairs/replacement, the vehicle is paid off, or you can't afford a high deductible, especially if the car is older and the payout won't cover much after deductible. It becomes a bad deal when the cost of premiums outweighs the actual cash value (ACV) of your car and your financial ability to self-insure for damages. 

What did Suze Orman say about social security?

Dave Ramsey suggests claiming Social Security at 62 and investing the money. Suze Orman advises waiting as long as possible and ideally until 70 to claim benefits. Orman's advice is more likely to be the right move for most seniors.

What are the biggest mistakes people make with Medicare?

The biggest Medicare mistakes involve missing enrollment deadlines, failing to review plans annually, underestimating total costs (premiums, deductibles, copays), not enrolling in a Part D drug plan with Original Medicare, and assuming one-size-fits-all coverage or that Medicare covers everything like long-term care. People often delay enrollment, get locked into old plans without checking for better options, or overlook financial assistance programs, leading to higher out-of-pocket expenses and penalties. 

Does Medicare cover 100% of hospital bills?

No, Original Medicare (Part A & B) does not cover 100% of hospital bills; beneficiaries pay deductibles, coinsurance, and copays, but you can get full coverage by adding Medicare Supplement (Medigap) plans or choosing a Medicare Advantage plan. Part A covers the first 60 days of a hospital stay (after a deductible), but after that, you pay daily coinsurance, and there's no limit on your total costs unless you have supplemental coverage.
 

Do I really need supplemental insurance with Medicare?

Supplemental insurance is advisable for those with Medicare to help cover out-of-pocket costs and gaps in coverage, offering financial protection for deductibles, coinsurance, and other medical expenses not fully covered by Medicare.

Does Medicare pay for a colonoscopy?

Yes, Medicare (Part B) pays for screening colonoscopies, covering 100% of costs if your doctor accepts assignment and no polyps are found, though you pay 15% if they remove tissue (making it diagnostic); frequency depends on your risk, generally every 10 years (average risk) or 24 months (high risk). 

What is the most popular Medicare supplement plan?

The most popular Medicare Supplement (Medigap) plan for new enrollees is Plan G, offering comprehensive coverage similar to the old Plan F but without covering the Medicare Part B deductible; however, Plan F remains popular for those already enrolled, while Plan N is also a top choice for lower premiums in exchange for some copays and deductibles, according to Boomer Benefits and KFF.
 

Does Medicare pay 100% for anything?

No, Original Medicare (Part A & B) does not cover 100% of costs; it typically pays about 80% after deductibles, leaving you with 20% coinsurance for many services, plus gaps like dental, vision, and most drugs, requiring you to pay out-of-pocket or get supplemental coverage like Medicare Advantage (Part C) or Medigap. Some preventive services are covered at 100%, but most care has cost-sharing. 

Is it better to have plain Medicare or Medicare Advantage?

Neither Original Medicare nor Medicare Advantage (MA) is universally "better"; the best choice depends on your healthcare needs, budget, and preference for provider choice, with Original Medicare offering nationwide provider freedom but requiring separate drug/supplement plans, while MA provides all-in-one coverage with networks and extra benefits like dental/vision but often requires referrals and has regional limits. 

What is the average cost per month for Medicare?

Medicare costs vary, but for 2026, the standard Part B premium is around $202.90/month, Part A is often $0, Medicare Advantage (Part C) averages low premiums (around $14-$34.50), and Part D (drugs) averages around $34.50-$38/month, but all costs depend on income, plan choice, and work history. Many people pay more for Part B or Part D if they have higher incomes or delayed enrollment. 

Is Medicare alone enough?

No, Original Medicare (Parts A & B) typically isn't enough because it doesn't cover prescription drugs (needs Part D), has no out-of-pocket spending limit, and misses routine dental, vision, and hearing care, leading most beneficiaries to add Medigap (Supplement) or choose Medicare Advantage (Part C) for comprehensive coverage. Deciding what's "enough" depends on your health, budget, and comfort with risk, as Original Medicare leaves significant costs to you. 

What will Medicare not pay for?

Medicare generally doesn't cover routine dental, vision (glasses/contacts), and hearing aids/exams, plus most long-term custodial care, cosmetic surgery, and most prescription drugs (though Part D helps with many Rx). It also excludes services deemed not medically necessary, like most chiropractic care, acupuncture, and over-the-counter meds, with exceptions for specific conditions or when part of other covered care. 

Does Medicare cover dental and vision?

NARRATOR: Medicare Part A and part B do not provide coverage for dental, vision and hearing. The icons of the toothbrush, eye exam, and human ear appear. All three of them have a red X marked overtop of them.

Why are doctors dropping Medicare patients?

Physician Medicare reimbursement dropped 33% since 2000, when adjusted for inflation, according to the AMA. As a result, Ferguson said, many practices—particularly small, independent ones—can no longer afford to absorb the losses. "It's gotten to a point where you can't absorb it.

Does everyone have to pay $170 a month for Medicare?

If you don't get premium-free Part A, you pay up to $565 each month. If you don't buy Part A when you're first eligible for Medicare (usually when you turn 65), you might pay a penalty. Most people pay the standard Part B monthly premium amount ($202.90 in 2026).

What is the 3 day rule for Medicare?

Medicare's "3-Day Rule" is a requirement for Skilled Nursing Facility (SNF) coverage: you must have a medically necessary 3-consecutive-day inpatient hospital stay (not counting discharge or observation time) before Medicare pays for SNF care, generally starting within 30 days of discharge. This rule ensures SNF stays are for recovery after significant hospital care, though Medicare Advantage plans or certain CMS initiatives (like ACOs/TEAM model) may offer waivers allowing direct SNF admission from home or shorter hospital stays.
 

What does Dave Ramsey say about Social Security?

Dave Ramsey views Social Security as a supplement, not a primary retirement income, emphasizing that relying on it is a "dumb" idea; he advocates for claiming benefits as early as 62 if you're debt-free to invest the money for potentially higher returns, while also warning about potential future cuts due to trust fund depletion and urging strong reliance on 401(k)s and IRAs. 

What is the $1000 a month rule for retirement?

The $1,000 a month retirement rule is a simple guideline stating you need about $240,000 saved for every $1,000 of monthly income you want from your investments in retirement, based on a 5% annual withdrawal rate ($240k x 0.05 / 12 = $1k/month). It's a motivational tool to estimate savings goals (e.g., $3,000/month needs $720k), but it's one-dimensional, doesn't account for inflation, taxes, or other income like Social Security, and assumes steady 5% returns, making a personalized plan essential. 

What are the four documents Suze Orman says you must have?

Financial guru Suze Orman says there are four documents you absolutely must have: a will; a revocable living trust; a durable financial power of attorney; and an advance directive for health care. “Durable” means it remains in force should you become incapacitated.