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The pros and cons of Medicare Advantage: Should you switch to a private plan?
Sarah Brady October 16, 2025 at 12:03 AM
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Pros and cons of Medicare Advantage (All_About_Najmi via Getty Images)
If you've never seen an ad for Medicare Advantage (MA), you might not have a TV. During a span of just two months in late 2022, MA providers ran an average of over 9,500 Medicare Advantage ads per day on broadcast television.
Between the volume of advertisements and the problematic nature of some MA marketing, it's not surprising that more than half of all Medicare enrollees — nearly 33 million people — are on Medicare Advantage plans. But while MA usually includes more types of coverage than Original Medicare, it doesn't necessarily deliver more care.
With open enrollment on the horizon and Medicare Advantage back in the news after a more than $25 billion increase in federal payments for 2026, here's what to know about private Medicare plans — including what to weigh when deciding between MA plans and traditional Medicare.
Coverage choices for Medicare
You have two choices when it comes to your basic Medicare coverage: either Original Medicare or Medicare Advantage. When you choose the original option, you get Medicare Part A (also known as hospital insurance) and Part B (medical Insurance).
The main reasons for choosing traditional Medicare include:
Part A is usually free
You can use any U.S. hospital or doctor that takes Medicare
You don't usually need referrals for specialists
Prior authorization is not needed for most covered services and supplies (with limited exceptions starting in 2026 for certain services in six states: Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington)
You might get Medicare coverage automatically — for instance, if you're 65 and already receive Social Security — or you may have to sign up so you'll have coverage when your employer's insurance plan ends. You can also switch plans under special circumstances or wait for Medicare open enrollment, which happens every year from October 15 through December 7.
🔍 Read more: Original Medicare vs. Medicare Advantage: Which should you choose for coverage?
The benefits of Medicare Advantage: How it's different
Medicare Advantage — or Part C — is an alternative to Medicare parts A and B. These plans are offered by private insurers that contract with Medicare.
Why would you choose Medicare Advantage over Original Medicare? Aside from heavy advertising, MA appeals to most people because it appears to give you more coverage at a lower premium. Like traditional Medicare, you get Parts A and B, but you usually get Part D drug coverage too, plus vision, hearing and dental insurance.
Here are a few reasons you might find MA appealing:
Your one plan can replace multiple plans
Average premiums are as low as $11.50 a month (a decrease from $13.32 in 2025)
There's a limit on your annual out-of-pocket costs, unlike Original Medicare
Part D coverage is usually included
Many plans include hearing, vision and dental coverage
Gym memberships or fitness benefits are often included
Of course, Medicare Advantage companies can exclude important facts about these plans. For example, you still have to pay a Part B premium with MA, and your options for where to get care are more limited. Also, coverage and rates advertised by MA carriers may not be available in your area.
You can sign up for MA when you first enroll for parts A and B or during annual Medicare Advantage open enrollment from October 15 to December 7. If you're already enrolled in an MA plan and want to change it, you also have the Medicare Advantage Open Enrollment Period from January 1 through March 31.
🔍 Read more: Simple ways to save money on your prescriptions — without skipping your meds
The drawbacks — and criticisms — of Medicare Advantage
Since private plans for Medicare were introduced in the 1980s, the program has faced challenges with funding and beneficiary choice. The main appeal of Medicare Advantage is lower premiums plus supplemental benefits like dental, vision and hearing coverage, which are a major draw for people budgeting with limited retirement savings and income.
But these plans come with trade-offs that aren't always apparent up front: restricted provider networks, prior authorization requirements that can delay or deny care and other limits on help that might not become apparent until you're in poor medical condition.
Dishonest marketing
To say that MA providers can use deceptive marketing is putting it lightly. On the whole, Medicare Advantage advertising is so misleading that the federal Centers for Medicare & Medicaid Services (CMS) put out a 226-page rule in 2023 to reign in MA's marketing practices and other major program issues.
Troublesome tactics highlighted in the CMS rule include:
MA marketing postcards designed to look like Medicare notices from the federal government
Providers overstating how much their plans could save customers
Benefits advertised in areas that didn't support them
Ads stating the ability to get money back from Social Security, even though the Social Security Administration's program was available in only two states
Perhaps even more troubling is MA's documented habit of marketing to people with dementia and enrolling customers or switching them to new plans without their consent, according to key Senate Finance Committee findings.
Why do MA carriers go to such lengths to get your business? The federal government pays them a substantial set rate — between $15,000 and $17,000 — for each plan participant. Total program spending in 2025 is projected to reach $500 to $600 billion.
Limited choice
Want to choose your own doctor or specialist? Medicare Advantage could make it tough.
With traditional Medicare, you can go to any U.S. hospital or doctor that takes Medicare, and you don't usually need referrals for specialists. However, with Medicare Advantage, you might need referrals for specialists from your primary physician. Plus, unless you opt for a pricier Medicare Advantage PPO plan, you're limited to in-network doctors and providers in your service area, which might not include specialists.
Unfortunately, if you rely on specialists, you can't believe what MA agents tell you about the availability of medical care in your area. Medicare Advantage provider directories can be filled with "ghost networks" — inaccurate provider listings and unavailable providers. Instead, you'll need to do your own research to confirm that specialized care will be available when you need it.
Less coverage
It can be harder to get approved for the care you need with Medicare Advantage than with Original Medicare. For example, while MA is supposed to provide the same psychiatric coverage as Medicare Parts A and B — such as therapy, mental health treatment and substance abuse disorder treatment — each MA plan can have different providers and levels of coverage. You also have to get prior authorization for most other services. In other words, your doctor or clinician has to get approval from the insurance company to have your services covered.
And approval isn't guaranteed — MA plans have a history of denying prior authorization:
MA service providers denied nearly 3.2 million of the requests they received in 2023, with Humana, Anthem, Centene and Blue Cross Blue Shield among the biggest offenders.
Beneficiaries appealed about 1 in 10 of those denied requests, with 82% of those appeals eventually overturned.
13% of all denied requests in 2022 met the Medicare coverage rules, meaning they would have been covered under a traditional Medicare plan.
48 members of the House and Senate wrote a letter in June 2024 urging CMS to curb MA providers' use of artificial intelligence to deny authorization requests.
Unfortunately, the track record of MA carriers explains why there's a documented pattern of seriously ill and high-needs patients switching from MA plans to Original Medicare.
Inconsistent quality
There are more than 40 available Medicare Advantage plans available from about 10 insurers, and they're not created equal.
The Centers for Medicare and Medicaid Services publishes Medicare Advantage star ratings to help you choose a provider, but their usefulness is limited. CMS ratings can be artificially high and may not give you insights into the quality of care available in your area, according to the Urban Institute.
Still, you might want to avoid what CMS calls "consistently low performers." Note that five out of eight of them are owned by the same company: Centene Corporation.
Worst-rated Medicare Advantage providers
Parent company
Buckeye Health Plan Community Solutions
Centene Corporation
Centene Venture Company Tennessee
Centene Corporation
Aetna Better Health of California
CVS Health Corporation
Meridian Health Plan of Michigan
Centene Corporation
Wellcare of Illinois
Centene Corporation
Zing Health
Zing Health Consolidator
Wellcare Health Insurance of the Southwest
Centene Corporation
Clear Spring Health Insurance Company
Group 1001
Source: 2025 Medicare Advantage and Part D Star Ratings, Centers for Medicare and Medicaid Services
🔍 Read more: 7 big changes coming to Social Security in 2026 (one that could shrink your check)
Should I sign up for Medicare Advantage?
If your only concern is finding the lowest monthly premium, you might carefully consider enrolling with a reputable Medicare Advantage provider. While Original Medicare Part B premiums are projected to be around $206.50 a month in 2026, MA premiums can be more budget-friendly at less than $12 a month on average.
Yet, despite more types of coverage, you're more likely to face obstacles in getting the care you need with Medicare Advantage, and you risk paying an annual out-of-pocket maximum that can reach up to $9,250 in 2026.
If you're not sure which option is best, start by calling Medicare's 24-hour hotline at 800-633-4277 (800-MEDICARE). Or talk it over with a Medicare specialist, a certified retirement counselor or unbiased support through your State Health Insurance Assistance Program.
Can I switch from Medicare Advantage if I need to?
Yes, you can switch between traditional Medicare and Medicare Advantage plans during open enrollment. Depending on the type of coverage you have — and, in some cases, your special circumstances — you may be able to enroll during one or more of the following periods:
October 15 to December 7 — switch to a different MA plan or between MA and Original Medicare plans
January 1 to March 31 — switch from one MA plan to another, or from an MA plan to Original Medicare
Special enrollment period — join an MA plan or switch between MA plans if you have a qualifying circumstance such as relocation or loss of coverage
🔍 Read more: How to find a trusted retirement advisor for peace of mind in your golden years
Medicare Advantage in the news
Medicare Advantage is back in the news after the Trump Administration announced in April a $25 billion increase in federal payments for Medicare Advantage plans starting in 2026 — the largest increase in a decade and a win for insurers like UnitedHealth Group and CVS Health.
UnitedHealth Group is the latest insurance giant at the end of a U.S. Justice Department probe into its billing practices and extra payments charged to its Medicare Advantage plans. This after for-profit insurer Humana announced in early September 2024 that it's cutting MA plans in 13 markets it found unprofitable, leaving some 560,000 beneficiaries to choose new plans. Still other Humana members will have fewer plans to choose from, depending on where they live.
🔍 Read more: Big tax changes are coming: 13 rules that may boost your refund — or shrink it
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FAQs: Protecting your health and assets in retirement
Learn more about insurance and protecting your money and assets with these common questions. And take a look at our growing library of personal finance guides that can help you save money, earn money and grow your wealth.
I'm retiring early and looking to cover the health insurance coverage gap before Medicare kicks in. What are my options?
If you quit work before you turn 65, you'll likely lose access to your employer's health insurance plan. It's still possible to get coverage, however — through a spouse, new employer or the health insurance marketplace, for example. But it may not be cheap. See a complete list of options in our guide to health insurance for early retirees.
Where can I get help in retirement?
Look into these helpful resources that can help you navigate challenges in retirement:
Local senior assistance programs. Many communities support programs specifically designed to assist low-income seniors, and each state has its own office or agency for the aging. To find these programs, contact your local Area Agency on Aging.
Benefits Checkup tool. The NCOA offers an online benefits tool that can connect you with programs to help pay for health care, medicine, food, utilities and more. Just enter your ZIP code to get started.
Government resources. Federal and state programs offer financial assistance for seniors, such as Supplemental Security Income (SSI) or Low-Income Home Energy Assistance Program (LIHEAP), which can help with basic living costs.
Volunteers of America. Among the nation's largest human-service organizations, Volunteers of America provides a wide range of services for the elderly, such as meal programs, transportation, help with Medicare enrollment, nursing care and affordable housing.
2-1-1 hotline. This FCC-supported hotline is your three digits for information and social services that can help with food, finances, transportation and other necessary support through more than 200 local organizations, including United Way, Goodwill and community action partnerships. Simply dial 2-1-1 for help or search for help by ZIP code.
About the writer
Sarah Brady is a finance writer and educator who covers a wide range of topics, from personal and small business credit and loans to financial scams. Her expertise has been featured in Yahoo Finance, Forbes Advisor, CNN, Fortune, Investopedia and other top media brands. As an NFCC-certified credit counselor, Sarah taught workshops on money management and coached thousands of clients on how to improve their credit. She is also a former HUD-certified housing counselor and educator for the City of San Francisco's affordable homebuyer programs.
Article edited by Kelly Suzan Waggoner
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October 16, 2025 at 01:18AM