If you'll be old enough to get Medicare coverage in 2026, you'll have a choice to make. You can either stick to original Medicare or sign up for a Medicare Advantage plan instead.
Medicare Advantage plans are offered by private insurers. They're required to offer at least the same level of care as Medicare.
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However, it's common for Medicare Advantage plans to offer supplemental benefits beyond what original Medicare covers. Many Advantage plans, for example, provide dental benefits and pay for eye exams and hearing aids -- all things enrollees in original Medicare must pay for on their own.
Another perk of Medicare Advantage plans is that they limit your annual out-of-pocket spending, which is something original Medicare doesn't do. When you're retired and on a fixed income that may be mostly Social Security, that's huge.
But while there are certain perks to choosing a Medicare Advantage plan, there are some big drawbacks to know about, too. Here are a few reasons why you may not want to get a Medicare Advantage plan this year.
1. Your favorite doctors may be out of network
When you've been seeing the same doctors for many years, there's a certain comfort level that gets established. Unfortunately, though, Medicare Advantage plans limit enrollees to specific provider networks. So you may not get to see your favorite doctors if they're not part of your plan's network.
You may be wondering: What happens if I go out of network? Often, that means your Medicare Advantage plan won't pick up the tab for your care. Or, it won't pay your costs in full, leaving you with larger bills.
2. You could face bottlenecks getting care
One thing Medicare Advantage plans are notorious for is requiring prior authorization for treatments or diagnostic tests that are more costly in nature. The purpose is to make sure that these services are really necessary.
The problem is that some Medicare Advantage plans have high denial rates for prior authorization requests. And the mere fact that you need to take that step means you risk facing delays in getting care.
3. You might struggle if you split your time between two states
Because Medicare Advantage plans limit enrollees to specific networks, you may find that it's a struggle to get the care you need if you spend a lot of time outside of your home state. So if you're a snowbird, or you tend to spend a lot of time in another state because your grown kids live there, you may want to consider original Medicare over Medicare Advantage.
With original Medicare, you can generally see any provider in the U.S. who accepts Medicare. So you may have a lot more choices for affordable care.
While there are plenty of benefits that come with enrolling in a Medicare Advantage plan, it's important to know what the pitfalls look like, too. Keep these three in mind before you make your decision.
