Jesse Smedley is a Principal of Oakbridge Insurance and the founder of iHealthBrokers. He founded iHealthBrokers in 2007, and Oakbridge acquired iHealthBrokers in 2025. He has spent nearly two decades teaching people how to save money on their health insurance and navigate Medicare, and he is the author of Medicare A to Z: Your Roadmap to Medicare.
Medicare Advantage plans have become extremely popular. Today, more than half of Medicare beneficiaries are enrolled in a Medicare Advantage plan instead of Original Medicare. Why?
Medicare Advantage plans are heavily advertised with appealing benefits: $0 monthly premiums, dental, vision and hearing coverage, prescription drug benefits, gym memberships, transportation services and more.
Those features sound attractive, but Medicare Advantage isn’t the right choice for everyone. Unfortunately, many people don’t realize there were better options until it’s too late to switch easily.
What Is Medicare Advantage?
Medicare Advantage (Part C) is an alternative to Original Medicare. You can’t use both at the same time.
Instead of getting your coverage directly from the federal government, you enroll in a plan offered by a private insurance company. These plans must cover everything Original Medicare covers under Part A (hospital insurance) and Part B (medical insurance), and most add extra benefits to attract members.
Some of the most common extras are prescription drug coverage (Part D), dental, vision and hearing. These are the benefits you usually see in the ads.
Important Limitations to Consider
Despite the added benefits, Medicare Advantage plans come with real restrictions.
Provider Networks
Medicare Advantage plans use networks, usually HMOs or PPOs. With an HMO, you generally must use doctors and hospitals in the plan’s network, and you may need a referral to see a specialist. A PPO gives you more flexibility, but your access is still more limited than with Original Medicare.
Original Medicare lets you see any doctor or hospital in the country that accepts Medicare.
Prior Authorization
Medicare Advantage plans are managed care plans, so the insurance company often requires prior authorization before it approves certain treatments or services. That paperwork can delay your care, and sometimes coverage is denied.
New federal rules aim to make approvals faster and more transparent, but prior authorization is still a common concern.
Who Should Avoid Medicare Advantage?
Three groups in particular should think twice before choosing a Medicare Advantage plan.
People Undergoing Cancer Treatment
If you’re receiving cancer treatment now, or expect to start soon, Medicare Advantage may not be your best option. Many plans charge up to 20% coinsurance for chemotherapy and infusion treatments, and that adds up fast.
If a chemotherapy treatment costs $10,000 and your plan charges 20%, you owe $2,000 for that one treatment. A few treatments can put you at your plan’s yearly out-of-pocket maximum, which can be as high as $9,250 for in-network care in 2026. Even with a $0 premium plan, you could pay that much every year you’re in treatment.
Networks matter just as much here. A Medicare Advantage plan may limit which oncologists you can see and which hospitals or cancer centers you can use. If your preferred specialist or cancer center is out of network, you may have to pay much more, or the full cost. With a serious, life-threatening condition, you want to keep your options open. Read more in our post on Medicare and cancer.
Why Original Medicare May Be Better
In this situation, Original Medicare with a Medigap plan is usually a better fit. Most out-of-pocket costs are covered, and you can see any doctor or hospital that accepts Medicare (almost all do). That gives you much more flexibility during serious treatment.
People Who Take High-Cost Injection or Infusion Drugs
Some medications are extremely expensive, and drugs covered under Part B (not Part D) can cost more with Medicare Advantage. These often include biologics, rheumatoid arthritis treatments, infusion therapies and, as mentioned above, chemotherapy.
Like chemotherapy, these drugs often carry up to 20% coinsurance in a Medicare Advantage plan. If your monthly infusion costs $5,000, 20% is $1,000 a month. You’d keep paying that until you reach your plan’s out-of-pocket maximum, and that maximum resets every January.
The Advantage of Medigap
With Original Medicare and a Medigap plan, the 20% Part B coinsurance is usually covered. Your healthcare costs become predictable, which can take a lot of financial strain off people who need expensive medication month after month.
Frequent Travelers and Snowbirds
If you travel often or live part of the year in another state, Medicare Advantage networks can be a problem. Most plans limit routine coverage to a specific service area. Doctor visits, lab work and follow-up appointments may only be covered by local, in-network providers. If you’re regularly on the move, it can be hard to schedule and keep up with your care.
One important note: emergency care is covered anywhere in the United States. Never avoid or delay treatment in a true medical emergency.
Why Original Medicare Works Better for Travelers
Original Medicare lets you see any provider nationwide that accepts Medicare. You can get routine care without network restrictions and travel without planning your care around a regional network.
Several Medigap plans also include limited coverage for emergencies during foreign travel. Learn more in Navigating Travel with Medicare.
Why Timing Matters
This is why some people find out too late. The best time to buy a Medigap plan is during your Medigap Open Enrollment Period: the 6 months that start the month you’re 65 or older and enrolled in Part B. During that window, companies can’t turn you down or charge you more because of your health. If you start with Medicare Advantage and want to switch to Medigap later, you may have to answer health questions and could be charged more or denied, depending on your state. If you’re about to turn 65, our Turning 65 guide walks through every deadline.
Get Help Choosing the Right Plan
Not sure whether Medicare Advantage or Medigap fits your health and lifestyle? Our licensed brokers will compare your options at no cost to you. Get your free quotes or call us at (866) 260-9829.
