For some, Medicare Advantage plans are a good coverage option. They provide extra benefits that provide value beyond Original Medicare coverage. That said, the best plan for you ultimately depends on your medications, doctors, and budget needs.
Medicare Advantage plans include extra benefits but use local provider networks, often require prior authorization, and have plan-specific rules and costs. On the other hand, Original Medicare gives access to a broad range of providers and doesn’t require prior authorization for covered services.
In this guide, we’ll go through the pros and cons of Medicare Advantage and how to determine if it’s right for you. And if you have any questions along the way, we’re happy to provide the answers. Reach out to Chapter’s licensed Medicare Advisors to compare plans and learn which options fit your budget and healthcare needs.
Key takeaways
Medicare Advantage plans are becoming more popular. Key advantages include extra benefits like dental, vision, and hearing coverage.
These plans often limit the doctors and hospitals you can use. They also come with higher out-of-pocket costs compared to Original Medicare combined with a Medigap plan.
When considering Medicare Advantage, carefully read the plan details. Make sure you understand out-of-pocket costs, which doctors are in network, and how the plan handles referrals and out-of-state travel.
Is Medicare Advantage worth it?
Medicare Advantage plans have grown in popularity. More than half (55%) of eligible Medicare beneficiaries are now enrolled in Medicare Advantage, up from just 19% in 2007. These plans can be a good option for people who want dental, vision, hearing, and prescription drug coverage, extra benefits, and lower premiums.
Medicare Advantage isn’t inherently good or bad; the best coverage option comes down to your unique situation. To decide if a Medicare Advantage plan is for you, consider the care you may need, review your budget, and check each plan’s network of providers and covered drugs.
Here’s when Advantage may be a good fit for you:
You want an all-in-one plan that covers prescription drugs and gives you extra benefits like dental, vision, and hearing coverage.
There’s a plan that covers your medications and has your doctors and hospitals in network.
There’s a plan with costs that fit your budget. Keep in mind that while Medicare Advantage plans often have low premiums, expenses like deductibles, coinsurance, and copays factor into the total cost.
You’re eligible for a Special Needs Plan (SNP). These are specific plans tailored to people with special needs, including those who have chronic conditions, need long-term care, or are eligible for Medicaid.
However, some people switch from Medicare Advantage to Original Medicare. Of the roughly 35 million enrolled in Advantage, one in 10 leave and return to Original Medicare due to access, cost, and quality issues.
Here are a few reasons you might want to avoid Medicare Advantage plans:
Your preferred doctors and hospitals are not in a plan’s network.
You often travel or spend time in different parts of the country.
You want easy access to a broad range of providers.
You want to avoid needing prior authorization.
You don’t want to risk having a Medicare Advantage plan that changes and no longer supports your healthcare needs. Each year, Medicare Advantage plans can change their benefits, networks, and covered drugs. And in 2025, 2.6 million Americans were on plans that were terminated, forcing them to look for new Medicare Advantage coverage.
How does Medicare Advantage compare to Original Medicare?
Medicare Advantage and Original Medicare are two different ways to receive Medicare benefits. Original Medicare is managed by the government and provides Part A (hospital and inpatient care) and Part B (outpatient care). For drug coverage, enrollees can purchase a Part D plan. With Original Medicare, you can also add a Medicare Supplement (also called Medigap) plan to reduce your out-of-pocket costs.
Medicare Advantage plans are a replacement for Original Medicare offered by private insurance companies. As a replacement, they are legally required to provide coverage at least as good as Original Medicare. These plans also typically include bundled prescription drug coverage and additional benefits like dental, vision, and hearing care that aren’t covered by Original Medicare. While you’ll still pay the Part B premium, the best Medicare Advantage plans often have low premiums. However, out-of-pocket costs can be high, networks restrict which doctors you can see, and plans may require (and deny) prior authorization for treatments.
Here’s a summary of the differences:
| Original Medicare | Medicare Advantage | |
|---|---|---|
| Provider access | You can see any doctor or hospital that accepts Medicare | Plans use local provider networks and may require referrals to see specialists |
| Extra benefits | You must get additional support for needs like dental, vision, and hearing. | Plans typically have access to extra benefits like dental, vision, and hearing care. |
| Prescription drug coverage | You don’t automatically receive coverage for prescription drugs. Enrollees usually purchase Part D coverage to fill this gap. | Plans often come with prescription drug coverage. |
| Prior authorization | You don’t need prior authorization for most services. | Plans often require prior authorization. |
| Out-of-pocket max | Original Medicare has no annual out-of-pocket maximum. | In 2026, the out-of-pocket maximum for Medicare Advantage plans is $9,250 for in-network services and $13,900 for combined in-network and out-of-network services. |
| Managed by | Federal government | Private insurance companies |
The drawbacks and benefits of Medicare Advantage plans
While Medicare Advantage offers extra benefits, these plans have tradeoffs. Let’s take a look.
Pros of Medicare Advantage plans
Many people choose Medicare Advantage plans because they include prescription drug coverage, put a limit on out-of-pocket costs, and come with extra benefits that Original Medicare doesn’t offer.
Here are the main perks:
Low to $0 monthly premiums: 65% of Advantage plans have a $0 premium, but you still owe the Part B premium.
Extra benefits: Many Medicare Advantage plans include dental, vision, and hearing coverage. They can also come with other benefits, like transportation assistance, fitness memberships, and over-the-counter benefits.
Bundled coverage: Medicare Advantage plans provide coverage for the same services and equipment as Original Medicare and usually include Part D coverage.
Annual out-of-pocket max: Medicare Advantage has an out-of-pocket maximum of $9,250 on in-network services and $13,900 on combined in-network and out-of-network services.
Cons of Medicare Advantage plans
Medicare Advantage plans have a somewhat negative reputation. People can have issues securing care, and some plans use deceptive practices.
Here are some potential disadvantages to consider:
Access limitations: Medicare Advantage plans only provide full coverage for care received from in-network doctors. If your provider is not in the network, you may be denied coverage or have to pay higher copays or coinsurance. Networks can be local or regional, so if you travel or have a second home in a different state, Medicare Advantage may not work for you.
Prior authorization denials: Medicare Advantage plans can require prior authorization, and denials are too common. Original Medicare rarely requires prior authorization.
Higher out-of-pocket costs: In 2026, the average out-of-pocket limit for Medicare Advantage enrollees is $5,421 for in-network services, and it’s $9,825 for in-network and out-of-network services combined. If you were on Original Medicare and added a Medigap plan, you’d have very limited out-of-pocket costs..
Difficulty comparing plans: There are thousands of Medicare Advantage plans nationwide, and each plan has different coverage, costs, and benefits. Comparing the plans available to you based on your unique healthcare needs and preferences can be time consuming and challenging.
Annual plan changes: Providers can change plan details each year, so enrollees need to review information each year to make sure their coverage still fits their needs.
Difficulty enrolling in Medigap later: When you’re first eligible for Medicare at age 65, you can buy any Medigap policy—and insurance carriers cannot deny your application. If you choose Medicare Advantage and decide you want to switch to Original Medicare with a Medigap plan later, the process may be more difficult depending on when you try to make a change, which state you live in, and your health history.
Questions to ask while comparing Medicare Advantage plans
Although the extra benefits can be helpful, don’t choose a plan based on these alone. Determine your specific healthcare needs, and base your Medicare plan comparison on those.
Here are a few questions to help you narrow down your priorities:
Are my current doctors in the plan’s network?
Does the plan cover my prescriptions, and how much will I need to pay for them per year?
What’s the annual maximum out-of-pocket cost?
Do I need a referral to see a specialist?
How will I get care if I travel or spend part of the year in another state?
How has the plan performed, and what’s its star rating?
Choose the Medicare option that fits your care needs
Medicare Advantage plans can be a great fit for some, but you may be better off sticking with Original Medicare and adding Medigap and a Part D plan. Which option is best comes down to the doctors and hospitals you use, your care needs, and your expected costs.
If you need help sorting through the details, we’re here to help. Get free, personalized Medicare advice from our licensed, independent Medicare Advisors. We’ll help you understand the tradeoffs between Medicare Advantage and Original Medicare before you enroll or switch plans.
Call us today at 855-900-2427, or book an appointment to find the right Medicare plan for your needs.
Sources
Kaiser Family Foundation (2026). Medicare Advantage in 2026: Enrollment Update and Key Trends. https://www.kff.org/medicare/medicare-advantage-in-2026-enrollment-update-and-key-trends/
Medicare (2026). Special Needs Plans (SNP). https://www.medicare.gov/health-drug-plans/health-plans/your-health-plan-options/SNP
Kaiser Family Foundation (2026). Most Medicare Beneficiaries Affected by Plan Terminations in 2025 Have Robust Medicare Advantage Options in 2026. https://www.kff.org/medicare/most-medicare-beneficiaries-affected-by-plan-terminations-in-2025-have-robust-medicare-advantage-options-in-2026/
U.S. Department of Health and Human Services Office of Inspector General (2026). Medicare Advantage Organizations Overturned Nearly All Appealed Prior Authorization Denials for Skilled Nursing Facility Admission, Raising Concerns About Initial Denials. https://oig.hhs.gov/reports/all/2026/medicare-advantage-organizations-overturned-nearly-all-appealed-prior-authorization-denials-for-skilled-nursing-facility-admission-raising-concerns-about-initial-denials/
Kaiser Family Foundation (2026). Medicare Advantage in 2026: Premiums, Out-of-Pocket Limits, Supplemental Benefits, and Prior Authorization. https://www.kff.org/medicare/medicare-advantage-in-2026-premiums-out-of-pocket-limits-supplemental-benefits-and-prior-authorization/
Kaiser Family Foundation (2025). Medicare Advantage 2026 Spotlight: A First Look at Plan Offerings. https://www.kff.org/medicare/medicare-advantage-2026-spotlight-a-first-look-at-plan-offerings/
