Pros and Cons of Medicare Advantage Plans

Reviewed October 5, 2026. The main pros of Medicare Advantage are low or $0 premiums in many areas, a yearly out-of-pocket maximum, drug coverage usually built in, and extra benefits such as dental, vision, hearing and fitness. The main cons are provider networks, prior authorization rules, costs that add up through copays when you use a lot of care, and limited rights to buy a Medigap policy if you want to switch back to Original Medicare later.

Quick answer: Medicare Advantage (Part C) often suits people who are comfortable using a local network and want predictable, lower monthly costs plus extras. Original Medicare with a Medigap plan often suits people who want to see any doctor nationwide that accepts Medicare, travel often, or expect significant medical care and prefer to pay a higher premium for fewer bills.

What is Medicare Advantage?

Medicare Advantage plans are offered by private insurance companies approved by Medicare. They provide your Part A and Part B coverage and must cover everything Original Medicare covers, except hospice care, which Original Medicare still pays for. Most plans also include Part D drug coverage. You still pay your Part B premium ($202.90 per month standard in 2026) in addition to any plan premium (Medicare.gov).

Pros and cons of Medicare Advantage at a glance

The advantages of Medicare Advantage plans

1. Lower monthly premiums

Many plans charge low or $0 premiums beyond the Part B premium. In its September 28, 2026 announcement, CMS projected that the average Medicare Advantage premium will fall from $14.37 in 2026 to $12.00 per month in 2027 (CMS). Compare that with a Medigap plan plus a stand-alone Part D plan, which together often cost more each month.

2. A cap on out-of-pocket costs

Original Medicare has no yearly limit on your 20% Part B coinsurance. Every Medicare Advantage plan sets a yearly out-of-pocket limit for covered Part A and Part B services. Once you reach it, Medicare.gov says, the plan pays 100% of covered health services for the rest of the year. The limit varies by plan, so check each plan’s maximum.

3. Drug coverage in one plan

Most Medicare Advantage plans include drug coverage (MAPD plans), so you don’t need a separate Part D plan. In 2026, out-of-pocket costs for covered Part D drugs are capped at $2,100, and the cap is adjusted each year. Learn more in how Medicare Part D works.

4. Extra benefits Original Medicare doesn’t cover

Plans may include routine dental, eye exams and glasses, hearing aids, fitness programs, transportation and over-the-counter allowances. See Medicare Advantage dental coverage, hearing aid coverage and our OTC card guide.

5. Coordinated care and special needs plans

HMOs often use a primary care provider to coordinate your care. Special Needs Plans (SNPs) are designed for people with certain chronic conditions, people who live in institutions, or people who have both Medicare and Medicaid.

The disadvantages of Medicare Advantage plans

1. Networks limit your choice of providers

HMOs usually cover only in-network care except emergencies and urgent care. PPOs cover out-of-network care at a higher cost. Doctors can leave a network during the year. Read Medicare Advantage HMO vs. PPO for the differences.

2. Prior authorization and referrals

Many plans require approval before you get certain services, such as advanced imaging, skilled nursing facility stays or some drugs, and HMOs often require referrals to see specialists. Original Medicare rarely requires prior authorization.

3. Costs can add up when you’re sick

Instead of a big monthly premium, you pay copays and coinsurance as you use care. If you have a serious illness, you could reach the out-of-pocket maximum, which can be thousands of dollars in a single year.

4. Limited coverage when you travel

Plans cover emergency and urgent care anywhere in the U.S., but routine care outside the service area is often limited. If you spend part of the year in another state, check whether the plan has a travel or visitor benefit.

5. Switching back to Medigap can be hard

If you leave Medicare Advantage for Original Medicare, insurers in most states can use medical underwriting for a Medigap policy, unless you have a guaranteed issue right, such as the trial right during your first 12 months in Medicare Advantage. Read how to switch from Medicare Advantage to Medigap and Medigap underwriting questions.

6. Plans change every year

Premiums, copays, drug lists, networks and extra benefits can change each January. Your plan sends an Annual Notice of Change by September 30. Review it every fall with our annual Medicare plan review checklist.

Medicare Advantage vs. Original Medicare with Medigap

For a deeper comparison of supplement plans, see what Medigap plans cover.

Who might Medicare Advantage suit?

• People in good health who want low premiums and are comfortable with a local network
• People who value dental, vision, hearing or fitness extras
• People who qualify for a Special Needs Plan, including those with both Medicare and Medicaid

Who might prefer Original Medicare with Medigap?

• People who want to see specialists without referrals or networks
• People who travel or live in more than one state
• People with ongoing serious health conditions who prefer predictable costs
• People who are in their Medigap open enrollment period now and may not qualify for Medigap later

How to decide for 2027

1. List your doctors, hospitals and prescriptions.
2. Check each plan’s network, drug list, out-of-pocket maximum and prior authorization rules.
3. Compare total yearly costs, not just premiums, using our Medicare plan comparison worksheet.
4. Make changes during Medicare Open Enrollment, October 15 to December 7, 2026, for coverage starting January 1, 2027.

Frequently asked questions

What is the biggest disadvantage of Medicare Advantage?

For many people, it’s the network and prior authorization rules, which limit which providers you can use and add approval steps. For others, it’s that switching back to Original Medicare later may mean they can’t buy a Medigap policy without health questions.

Is Medicare Advantage cheaper than Medigap?

Monthly premiums are usually lower with Medicare Advantage. Total costs depend on how much care you use, because Medicare Advantage relies more on copays and coinsurance.

Can I switch from Medicare Advantage back to Original Medicare?

Yes, during Open Enrollment (October 15 to December 7), the Medicare Advantage Open Enrollment Period (January 1 to March 31), or a Special Enrollment Period if you qualify. Getting a Medigap policy may require medical underwriting unless you have a guaranteed issue right.

Do Medicare Advantage plans cover everything Original Medicare does?

Yes, except hospice care, which Original Medicare covers even if you’re in a Medicare Advantage plan. Plans can charge different cost-sharing and require prior authorization.

Do I still pay the Part B premium with Medicare Advantage?

Yes. You keep paying the Part B premium, $202.90 per month for most people in 2026, unless a program like Medicaid pays it or your plan offers a Part B giveback.

This article is general information, not individual insurance advice. Medicare365 is not affiliated with or endorsed by the U.S. government or the federal Medicare program.

Official sources

• Medicare.gov: Compare Original Medicare and Medicare Advantage
• Medicare.gov: Understanding Medicare Advantage Plans (booklet)
• Medicare.gov: Medicare costs
• CMS: Medicare Advantage and Part D expected to remain stable in 2027
• CMS: 2026 Medicare Parts A and B premiums and deductibles