5 Things Medicare Advantage Plans Won’t Tell You (That Could Cost You Thousands)

1. Out-of-Pocket Costs Can Be Much Higher Than You Think

Medicare Advantage plans often advertise $0 monthly premiums—and while that sounds great, the real costs come when you start using the plan.

Here’s the catch:
You’ll typically pay out-of-pocket for nearly every service, including:

• Hospital stays
• Surgeries
• Cancer treatments
• Ambulance rides
• Specialist visits

In 2025, the average out-of-pocket maximum for Medicare Advantage plans is around $8,000 per year. And that resets every single year.

So if you get sick or need surgery, those “savings” can disappear quickly. Original Medicare paired with a Medigap plan might cost more monthly—but you’ll know what to expect, and you won’t get hit with surprise bills.

2. You’re Locked Into a Local Network That Can Change Anytime

Most Medicare Advantage plans are HMO or PPO models, which means you’re restricted to a local provider network.

If your doctor or specialist isn’t in-network, you may have to:

• Pay more out of pocket
• Or be denied coverage entirely

Even worse, networks can and do change every year. We’ve seen clients lose access to their doctors midyear when a provider drops out of a network.

If you want true freedom to see any doctor in the U.S. who accepts Medicare, a Medicare Supplement plan may be a better fit.

3. Prior Authorization Can Delay or Deny Your Care

Here’s something most Advantage plans don’t highlight: you often need prior approval before getting care.

That means before you can:

• Get an MRI
• Have surgery
• See a specialist

Your plan might need to review and approve it first.

This process can delay your treatment—and sometimes deny it altogether.

In fact, a federal audit recently found that millions of necessary services were wrongly denied by Medicare Advantage plans. That’s a big risk if you have serious health concerns.

Original Medicare doesn’t have these same approval roadblocks.

4. Extra Benefits Sound Great—Until You Read the Fine Print

Dental, vision, hearing, gym memberships—those “bonus” benefits can sound amazing in Advantage plan brochures.

But look closer, and you’ll often find:

• Dental only covers basic cleanings
• Vision might just include one eye exam and a small allowance for glasses
• Hearing aid coverage may be limited to one low-end model every few years

Many of these benefits are bare minimum and come with restrictions, copays, or limited providers. In many cases, they’re more about marketing than actual value.

5. Switching Back Later Isn’t Always an Option

One of the biggest Medicare myths is that you can start with an Advantage plan now and switch to a Supplement plan later if you don’t like it.

But here’s the truth:
If you want to switch after your initial Medicare enrollment period, you may have to pass medical underwriting—and if you have certain health conditions, you can be denied coverage altogether.

That means you could be stuck with your Advantage plan for life, even if your health changes and your needs increase.

If you want flexibility and peace of mind down the road, it’s crucial to start with the right plan upfront.

Recap: 5 Things They Don’t Tell You About Medicare Advantage

Let’s summarize the hidden truths about Advantage plans:

1. High out-of-pocket costs (up to $8,000/year)
2. Local provider networks that may not include your doctors—and can change anytime
3. Prior authorizations that delay or deny care
4. “Extra” benefits that are often limited or disappointing
5. Switching later to a Supplement plan may require health approval—and you could be denied

So, What Should You Do?

If you’re evaluating Medicare Advantage vs. Medicare Supplement plans, don’t do it alone. There’s no one-size-fits-all solution.

Here’s what I recommend:

• Review your total cost exposure, not just monthly premiums
• Make sure your doctors and prescriptions are covered
• Think about your future health and travel needs
• Talk to an expert before you enroll

Need Help? Let’s Talk.

If you want to compare Medicare plans and make the best decision for your health and budget, we’re here for you.

Call us today at 800-208-4974 to book a free consultation.

We’ll help you:

• Understand all your options
• Check your doctor and drug coverage
• Compare Supplement vs. Advantage plans
• Lock in the best plan for 2025