What is the biggest disadvantage of Medicare Advantage?

The biggest disadvantage of Medicare Advantage (MA) is often restricted provider networks, complex approval processes (prior authorizations), and unpredictable annual changes to costs and coverage, which can limit your choice of doctors, make accessing specialists harder (requiring referrals), and leave you with unexpected out-of-pocket costs, especially if you have chronic conditions or travel.

Why do people say not to get a Medicare Advantage Plan?

People warn against Medicare Advantage (MA) plans due to limited doctor/hospital networks, complex pre-authorization for care, higher potential out-of-pocket costs for serious illnesses, annual plan changes (benefits/networks), denials of care, and difficulty switching back to Original Medicare with a Medigap plan later, especially if you become sick. While MA offers extra perks (dental, vision, low premiums), these restrictions can be burdensome, prioritizing insurer profits over patient freedom, making it risky for those with ongoing health issues. 

Can I drop my Medicare Advantage Plan and go back to original Medicare?

Yes, you can drop your Medicare Advantage (MA) plan and return to Original Medicare, typically during the Annual Enrollment Period (AEP) (Oct 15–Dec 7) or the MA Open Enrollment Period (OEP) (Jan 1–Mar 31), though you may qualify for a Special Enrollment Period (SEP) if you move or have other qualifying life events, but be aware you'll need to get a Part D plan and might want a Medigap plan to help with costs. 

Why do people get Medicare Advantage?

You might need a Medicare Advantage (MA) plan for its convenience and extra benefits (like dental, vision, hearing, fitness) not covered by Original Medicare, built-in prescription drugs (Part D), a yearly cap on out-of-pocket costs, and coordinated care, though they often use provider networks requiring referrals, unlike Original Medicare's freedom. It's an alternative to Original Medicare (Parts A & B) if you prefer one single plan with potentially lower monthly premiums and added wellness perks, but you must compare it with Medigap (Medicare Supplement) for your specific needs, says AARP and Consumer Reports. 

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. 

Original Medicare vs. Medicare Advantage: What's the Difference?

What is the best health insurance for seniors on Medicare?

There's no single "best" health plan, as it depends on your needs, but top providers for Medicare Advantage (Part C) include Humana, UnitedHealthcare, Aetna, and BCBS, offering diverse benefits like $0 premiums, extra perks, and strong networks, while Medigap (Medicare Supplement) complements Original Medicare by filling gaps, with popular carriers like AARP/UHC, Anthem, and Cigna providing standardized policies (Plans G, F, N), with personalized choices best found via your State SHIP counselor or broker. 

Which Medicare Advantage plan denies the most claims?

Centene (Wellcare) and CVS Health (Aetna) have faced scrutiny for high prior authorization denial rates in Medicare Advantage (MA) plans, with reports showing they had the most denied requests in 2023, though many denials were overturned on appeal, indicating issues with their strict criteria, while UnitedHealthcare also faces lawsuits and uses technology that has led to increased denials, especially for post-acute care, highlighting systemic challenges with MA plan claim approvals. 

Why are doctors dropping Medicare Advantage?

Doctors and hospitals are leaving Medicare Advantage (MA) plans primarily due to low reimbursement rates, burdensome prior authorization requirements leading to denied care, slow payments, and excessive paperwork, all impacting finances and patient care quality, with many providers finding the administrative load outweighs the benefits. They seek better payment rates or leave networks to avoid financial strain and care delays, even if it disrupts patient access to preferred providers like the Mayo Clinic or NewYork-Presbyterian. 

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. 

What is the most highly rated Medicare Advantage plan?

There's no single "most highly rated" Medicare Advantage plan nationwide, as ratings vary by location and insurer, but Kaiser Permanente often leads in integrated care markets (like CA) for high CMS & J.D. Power scores. Aetna gets high marks for nationwide reach & ratings, while UnitedHealthcare, Humana, and SCAN Health Plan are consistently strong performers with high CMS Star Ratings and member satisfaction, often offering $0 premium options and extra benefits. 

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. 

What is the 7 month rule for Medicare?

This is called your Initial Enrollment Period. It lasts for 7 months, starting 3 months before you turn 65, and ending 3 months after the month you turn 65. My birthday is on the first of the month.

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. 

Why are hospitals refusing Medicare Advantage plans?

Across the country, health systems report that Medicare Advantage's growing administrative burden — from denied authorizations to delayed reimbursements — has become unsustainable. Some hospitals have already ended their contracts; others are limiting participation to only a few select plans.

How do I switch back to original Medicare?

To switch back to Original Medicare from a Medicare Advantage plan, you must disenroll during specific periods (like Annual Enrollment Oct 15-Dec 7 or MA Open Enrollment Jan 1-Mar 31), enroll in a separate Part D drug plan (which automatically cancels the MA plan), and consider applying for a Medigap policy for cost-sharing help, but be aware of underwriting rules for Medigap. You can initiate the change by contacting your MA plan or Medicare directly at 1-800-MEDICARE or via Medicare.gov, often using your online account to find plans and manage changes. 

Is it better to have straight Medicare or a Medicare Advantage plan?

Neither Original Medicare nor Medicare Advantage (MA) is inherently "better"; the best choice depends on your health, budget, and lifestyle, with Original Medicare offering provider freedom and MA providing bundled benefits (dental/vision) and cost predictability via an out-of-pocket maximum, but often with network restrictions. Choose Original Medicare + Medigap for nationwide access and no networks, ideal for travelers or those wanting maximum choice, while Medicare Advantage suits those wanting all-in-one coverage (including drugs/extras like dental/vision) with lower upfront costs and a cap on yearly spending, provided they stay in-network. 

Who is the largest Medicare Advantage provider?

UnitedHealthcare is the largest Medicare Advantage (MA) provider by enrollment and market share, followed by Humana, with both companies dominating the market, especially in county-level presence, while CVS Health (Aetna) and Elevance Health are also major players, according to recent 2024-2025 data from KFF. UnitedHealthcare leads with nearly 10 million enrollees as of March 2025, offering broad availability and large provider networks, making it a consistent market leader. 

Is UnitedHealthcare getting rid of Medicare Advantage plans?

So the company did what monopolies often do when the numbers turn bad: It made cuts that affect its customers. UnitedHealth now plans to exit unprofitable Medicare Advantage and Affordable Care Act products, raising rates on ACA plans by about 26% alongside other health insurers.

What states have the worst Medicare Advantage plans?

States often cited for weaker Medicare Advantage performance include Louisiana, Mississippi, Kentucky, West Virginia, and Florida, due to challenges with care access, provider shortages, and quality issues like higher rates of avoidable hospitalizations and inappropriate medication prescriptions, though specific rankings vary by report and focus (e.g., satisfaction vs. overall system). Other states like New York, California, Texas, and Michigan appear on lists for low member satisfaction with specific plans, not necessarily the whole state's system. 

Is Blue Cross or UnitedHealthcare better?

UnitedHealthcare gets slightly higher overall star ratings than BCBS and may offer lower prices, but BCBS might offer a better customer experience.

What insurance company has the most complaints?

There isn't one single company with the "most" complaints universally, as it varies by insurance type (auto, home, health) and reporting agency, but Allstate frequently appears at the top of "worst" lists for auto/property due to aggressive claims tactics (lowballing, delays). For home insurance, companies like American Bankers and Spinnaker show high complaint ratios, while some reports point to high denial rates for health insurers like AvMed and UnitedHealthcare. 

What insurance provider denies the most claims?

In 2023, roughly one third of all in-network claims made to AvMed were denied by the medical insurance company. In this year, AvMed and United HealthCare were the medical insurance companies with the highest denial rate for in-network claims in the United States, at 33 percent each.

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). 

How do I get dental and vision coverage with Medicare?

If you have a Medicare Supplement plan, Part D plan, or both, you may want to purchase an Individual plan to cover dental and vision care. Most Anthem Medicare Advantage plans include built-in coverage for routine dental and vision care.