4 Big Problems With Medicare Advantage All Retirees Need to Know About

Once you turn 65, you'll generally be able to sign up for Medicare. But you don't have to stick to original Medicare. Instead, you could sign up for a Medicare Advantage plan.

Medicare Advantage plans are offered by private insurers, and they're required to offer at least the same level of coverage as original Medicare. But it's common for Medicare Advantage plans to offer supplemental benefits beyond what original Medicare covers.

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Another draw of Medicare Advantage? These plans come with an annual cap on out-of-pocket spending. Original Medicare doesn't.

Despite these benefits, there are some serious problems with Medicare Advantage plans you should know about. Keep these four on your radar before signing up.

1. Provider networks can be limited

With original Medicare, you can see any provider in the country who accepts Medicare. With Medicare Advantage, you're generally limited to a specific network of providers, which means your preferred doctors may not be on that list.

Going out of network, however, can be very expensive. Your plan may not cover those visits at all unless you're receiving emergency care.

2. Costs can be significant even with $0 premium plans

While there can be savings with Medicare Advantage, that's not guaranteed. A good number of Medicare Advantage plans offer $0 premiums. That, combined with extra benefits, offers enrollees a chance to save money.

But Medicare Advantage plans can also come with higher coinsurance costs for specialized care. And these plans' out-of-pocket maximums can range into the thousands. So all told, you might spend more as a Medicare Advantage enrollee, even if your plan doesn't charge a monthly premium.

Also keep in mind that enrolling in Medicare Advantage does not let you off the hook from paying Part B premiums. So while you may not pay a premium for your specific plan, you're still paying something off the bat.

3. Prior authorization requirements can delay care

Medicare Advantage plans are notorious for requiring prior authorization for services and treatments that are more complex and costly in nature. That could lead to major delays in care, not to mention open the door to a world of aggravation.

4. Plan rules can change from year to year

When you sign up for a Medicare Advantage plan, you're not guaranteed to have the same costs, in-network providers, and benefits every year. Medicare Advantage plans can change from one year to the next, forcing you to frequently have to explore new plan options.

Granted, the same can be said for Part D drug plans, which enrollees in original Medicare need. But with original Medicare, you don't necessarily have to worry about frequent provider network changes.

All told, Medicare Advantage works well for some retirees. But it's not guaranteed to be a good fit for you. Before you sign up for it, do your research and compare your plan choices to ensure you're making a wise decision.

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