Medicare Advantage Has a Coverage Gap That Could Hurt Your Health

Many retirees choose Medicare Advantage plans over traditional Medicare because Advantage plans often promise to cover services that traditional Medicare doesn't.

However, Advantage plans don't come without downsides. And one recent analysis shows there may be a coverage gap that could hurt your health. Here's why.

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Are Medicare Advantage plans missing coverage for a key service?

According to a December 2025 study published by The American Journal of Managed Care, there may be "potential care gaps or unmet needs" in Medicare Advantage plans.

Those coverage gaps are related to mental health services.

The study discovered this potential problem by looking at the use of mental health services among retirees who had a Medicare Advantage plan but then switched their coverage.

The researchers found that the change to traditional Medicare was associated with an increase in mental health visits, as well as a shift in provider composition.

Specifically, those who went back to traditional Medicare were much more likely to see mental health professionals more often, but to visit emergency medicine specialists and internal medicine physicians less often.

Medicare Advantage has narrow networks, and it could be a problem

Unfortunately, Medicare Advantage may not be offering seniors as much access to mental health services because many plans have narrow networks.

Research from the Kaiser Family Foundation published in 2025 revealed that seniors enrolled in Medicare Advantage had access to around half of the providers that those enrolled in original Medicare could see.

And a report from the Office of the Inspector General (OIG) of the Department of Health and Human Services revealed that many Advantage plans had limited networks of behavioral health providers, and that some caregivers listed as providers were not actually available.

Since it's not uncommon for seniors to struggle with the transition to retirement as they leave their jobs behind and begin relying on Social Security and income from retirement plans, limited access to mental health services could become a big problem.

The OIG's report also found that it may not be immediately clear to seniors signing up for Advantage plans that there are so few mental health service providers because inactive providers are often improperly listed.

This can make it challenging for struggling retirees to figure out if the Advantage plan they are choosing will provide the support they need.

As you consider your healthcare choices as part of your retirement planning process, it's important to think about issues like this.

You don't want to forgo essential care or get stuck paying for it out of your 401(k) because your insurance doesn't provide adequate coverage, so think carefully about which Medicare options are right for you.

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