Medicare's open enrollment period has been underway for more than a month now. And at this point, you have only a few more weeks to make changes to your health coverage for 2026.
One option you may be considering is switching from original Medicare to a Medicare Advantage plan. There can be benefits to moving onto Medicare Advantage, but drawbacks as well. Here's what you need to know if you're thinking of signing up for Medicare Advantage for the first time.
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1. You might get more services covered
When you're living on a fixed retirement income that consists of savings and Social Security, it's important to budget carefully for healthcare expenses. Many retirees are surprised to learn that there are a number of key healthcare services that Medicare won't pay for as a matter of course, including dental cleanings, eye exams, and hearing aids.
One nice thing about Medicare Advantage plans is that they commonly offer supplemental benefits beyond what original Medicare pays for. Those benefits often include dental care, eye exams, and hearing aids. Some Medicare Advantage plans even offer fitness and nutrition benefits, which could result in big savings.
2. You'll have a yearly limit on out-of-pocket medical spending
Another pitfall of original Medicare is that there's no cap on annual healthcare spending. Again, when you're no longer working and are living off of your individual retirement account (IRA) and monthly Social Security checks, that can be a tough thing to manage.
Medicare Advantage plans, on the other hand, do have an annual cap on out-of-pocket healthcare spending. That might give you peace of mind if you tend to have large medical bills or if money is generally tight in retirement.
3. You may not save money compared to original Medicare
Some Medicare Advantage enrollees find that their costs are lower compared to original Medicare, especially since a good number of Advantage plans come with a $0 monthly premium. But that doesn't mean you're guaranteed to save money.
You may incur other expenses as a Medicare Advantage enrollee, like higher copays and deductibles. You'll need to do the math carefully to see whether Medicare Advantage truly makes sense based on your specific health and prescription needs.
4. You'll be limited to a specific provider network
One nice thing about original Medicare is that it allows you to see any provider in the country who accepts Medicare. With Medicare Advantage, you're typically limited to a specific network of healthcare providers that's generally based on your location.
That could prove problematic for a couple of reasons. First, it could mean not getting to see your preferred doctors. Secondly, if you do a lot of traveling or spend a meaningful amount of time in another part of the country, you might struggle to get access to covered providers.
Going outside of your Medicare Advantage plan's network could mean facing huge out-of-pocket costs that strain your retirement savings. So, that's something you'll need to consider carefully.
5. You might have to deal with bottlenecks
It's very common for Medicare Advantage plans to require prior authorization for various procedures and diagnostic exams. But that could lead to delays in getting the care you need.
Having to get prior approval for tests and appointments might also be stressful. You may have less hassle getting access to care if you decide to stick with original Medicare.
It's definitely worth exploring your Medicare Advantage plan choices during fall open enrollment. If you don't do the research, you won't know what's out there. Just keep these general points in mind if you're not super familiar with Medicare Advantage, as they might help sway your enrollment decision for 2026.
