fbpx

Category: Medicare

9 Surprising Disadvantages to Medicare Advantage Very Few People Know

admin |

Depending on your budget, health, and plans for the future, Medicare Advantage might not be the best retirement health care solution for you.

Once you reach age 65, you become eligible for Medicare, the federal government’s health insurance program primarily geared toward seniors and retirees.

Whether you retire early or plan to work for several more years, have already turned 65, or are still a few birthdays away, it’s worth thinking about which Medicare plan you’ll sign up for when the time comes.

Medicare Advantage, or Medicare Part C, is one Medicare plan option, but is it the best choice for you, or should you stick with Original Medicare?

Here we’ll cover nine major reasons Medicare Advantage could conflict with your retirement goals, so you’ll have a better understanding of whether Medicare Advantage could work for you or if you should explore other Medicare coverage options.

It has a much smaller healthcare provider network

Most, though not all, American health care providers accept Original Medicare insurance. The same can’t be said for Medicare Advantage, which has a much smaller provider network.

If you’re trying to keep your current doctor, then it could lower your financial stress if you make sure they are in the network before going for a visit.

If finding a provider you love is important to you, Original Medicare will give you more options. With Medicare Advantage, you’ll have to settle for the best care you can find within the network.

Its service area is much smaller

Since Medicare is administered by the federal government, you can use it at any hospital or medical provider in the United States (as long as that provider accepts Medicare, which most do).

In contrast, Medicare Advantage’s smaller provider network is also extremely localized. Whenever you’re seeking non-emergency care, you’re limited to providers in your immediate area.

Its provider network is especially small for rural communities

No matter where in the country you live, Medicare Advantage’s network is smaller than Original Medicare’s network, but the network is especially limited for rural communities.

According to one study published in 2021, 10.5% of rural retirees who sign up for Medicare Advantage end up switching to original Medicare.

By way of comparison, only 5% of non-rural retirees switch away from Medicare Advantage.

It usually requires referrals to see specialists

With original Medicare, you typically can schedule a specialist visit even without a referral. With Medicare Advantage, you can’t simply call a specialist and schedule an appointment.

Instead, you may need a referral from a primary health care provider before you can speak with a specialist.

Pro tip: You may need to make some extra money if you have a health condition that requires frequent trips to a specialist.

It requires preauthorization for most high-cost services

Medicare Advantage plans often require preapproval for services such as inpatient hospital stays, dialysis, physical therapy, and psychiatric care. If you don’t get prior authorization when required, you may be responsible for the costs. Original Medicare, by contrast, generally doesn’t require preauthorization for these services.

It often requires preauthorization for Part B medications

Medicare Part B is the medical insurance section of Medicare, and it’s included in all Medicare Advantage plans.

However, you’ll need prior approval before your Medicare Advantage plan will help pay for any outpatient drugs prescribed under Part B (rather than Part D, which covers most other prescriptions).

Most Part B drugs that require preauthorization are injectable, including injectable medications for osteoporosis, injectable blood-clotting factors for hemophilia, and some oral and injectable end-stage renal disease medications.

It can require step therapy for Part B drugs

Step therapy refers to the practice of using a cheaper medication to treat a condition before moving to a more expensive medication.

Unlike original Medicare, Medicare Advantage plans can require step therapy for Part B medications, meaning your Medicare Advantage plan can refuse to cover medication prescribed by your doctor if there’s a cheaper alternative.

It might make hospital stays more expensive

Medicare Advantage might be cheaper for some retirees, especially those who mainly see healthcare providers for preventative health.

But if you end up in the hospital for a week, studies show that 50% of seniors using Medicare Advantage will pay more for that stay than seniors using original Medicare.

In other words, if you have poor health and know you’re at a higher risk of hospitalization, Medicare Advantage might cost you more over time than original Medicare.

It can make budgeting for health care even harder

Budgeting for health care can be tricky, especially on a fixed income. Original Medicare charges a predictable monthly premium, though you may still pay deductibles and coinsurance. Medicare Advantage plans often have lower or even $0 premiums, but you pay copays and coinsurance for services until reaching the plan’s out-of-pocket maximum, which can make monthly costs harder to predict.

Bottom line

Medicare Advantage plans can offer crucial benefits that make life easier for some retirees, especially those in good health with relatively few health care needs.

But it’s definitely not the right choice for everyone. You should weigh the pros and cons of your situation before making a final decision.

If you anticipate hospital stays, prefer to pick your own provider, and dislike the idea of getting prior approval for most expenses, original Medicare might be a better choice for you since you won’t need to make extra money to pay for insurance.

Author Details

Michelle Smith

Michelle Smith, a writer for FinanceBuzz, has spent a decade writing for and about small businesses. She specializes in all things finance and has written for publications like G2 and SmallBizDaily. When she’s not writing for work at her desk, you can usually find her writing for pleasure near large bodies of water.

🌵 Why I’m Advising My Arizona Clients to Choose Plan G in 2026

Andy |

As a local insurance expert helping retirees from Phoenix to Tucson, and across the Valley, I’m seeing a big shift this year. Many of my neighbors are asking if they should stick with a Medicare Advantage plan. While those “zero-premium” ads are everywhere in Arizona, there’s a lot they don’t tell you.

After reviewing the latest industry updates, I’m personally recommending Medicare Supplement Plan G for those who want total freedom and financial peace of mind. Here is why:

1. I want you to have “No-Hurdle” healthcare 🛑 A major issue with many plans right now is “prior authorization”—where the insurance company has to approve a procedure before you can get it. This causes delays that none of us want. With Plan G, if Medicare covers it, your supplement pays. I want the decision-making in your doctor’s hands, not a corporation’s.

2. See any doctor in Arizona (and the U.S.) 🏥 I hate seeing my clients limited by restricted networks. Whether you want to see a specialist at the Mayo Clinic in Scottsdale, a provider in Flagstaff, or even a doctor while visiting family back east, Plan G lets you go anywhere that accepts Medicare. No networks, no “out-of-network” penalties.

3. The ultimate “Snowbird” protection ✈️ Many of my clients in Mesa, Surprise, and Sun City split their time between states. Advantage plans are often tied to your local Arizona zip code. Because Plan G is nationwide, your coverage is just as strong in the Midwest as it is here in the desert.

4. No “Surprise” medical bills 💰 Advantage plans often have co-pays for every visit and hospital stay. I prefer the predictability of Plan G. Once you meet the small annual Part B deductible ($283 in 2026), your out-of-pocket costs for Medicare-covered services are zero. No more worrying about what the mail will bring after a doctor’s visit.

Your health deserves more than a “pay-as-you-go” plan. If you live in Scottsdale, Chandler, Peoria, or anywhere in the Grand Canyon State, let’s talk about how to protect your retirement.

👉 Give me a call today to discuss your 2026 options!

Contact Me Today

#ArizonaMedicare #MedicareSupplementArizona #PlanG #PhoenixHealthInsurance #TucsonRetirement #SunCityMedicare #MedicareExpertAZ #MedigapArizona #ScottsdaleSeniors

The Hidden Medicare Surcharge That Hits Retirees With Over $109,000 in Income

Andy |

Christy Bieber

Many seniors who are 65 and over rely on Medicare to provide them with healthcare coverage, and with good reason. Medicare is available from the government regardless of your health status. It provides coverage for a broad array of services (typically without requiring pre-approval), and it usually comes with affordable premiums.

The keyword, there, however, is usually.

Medicare premiums for most seniors come in at $202.90 for Medicare Part B in 2026. However, some seniors will find themselves hit with an unexpected Medicare surcharge that they may not have been expecting — and that could have a serious impact on their finances. Here’s why these surcharges happen and what it could mean for you.

If your income is $109,000 or higher, you could face a surprise Medicare hit

The Medicare surcharge that you could find yourself surprised by results from something called the Income-Related Monthly Adjustment Amount, or IRMAA.

IRMAA causes your Medicare Part B and Medicare Part D premiums to increase dramatically once your income goes above a specific threshold. That threshold is $109,000 for single tax filers and $218,000 for married joint filers. However, while this is the threshold in 2026 that will send your Medicare premiums surging, it’s not your 2026 income that matters, or even your 2025 income.

The income that matters is your Modified Adjusted Gross Income (MAGI) from two years earlier. So, if your MAGI in 2024 was above those thresholds, then you’ll be faced with higher Medicare premiums in 2026. This can come as a shock, as you may not be aware that a year of higher-than-normal income due to something like capital gains from selling high-performing investments could end up being a ticking time bomb that causes your Medicare premiums to substantially increase two years later.

How much higher will your Medicare premiums go?

The increase in Medicare premiums that results once your income exceeds IRMAA thresholds can be extremely substantial. The table below shows how much you can expect to pay in monthly premiums based on your MAGI and the Income-Related Monthly Adjustment amount:

Full Part B Coverage
Single tax filers with a MAGI that is: or Joint tax filers with a MAGI that is: 

Will pay an IRMAA equal to:

Bringing total Medicare premiums to:
Less than or equal to $109,000 Less than or equal to $218,000

$0.00

$202.90
Greater than $109,000 and less than or equal to $137,000 Greater than $218,000 and less than or equal to $274,000

$81.20

$284.10
Greater than $137,000 and less than or equal to $171,000 Greater than $274,000 and less than or equal to $342,000

$202.90

$405.80
Greater than $171,000 and less than or equal to $205,000 Greater than $342,000 and less than or equal to $410,000

$324.60

$527.50
Greater than $205,000 and less than $500,000 Greater than $410,000 and less than $750,000

$446.30

$649.20
Greater than or equal to $500,000 Greater than or equal to $750,000

$487.00

$689.90

That means you could be looking at paying as much as $487 extra per month — and paying total premiums as high as $689.90 — because you had a year when your income was high. Of course, if you have many years of high earnings as a retiree, you could be hit with this surcharge for the entirety of your retirement during the years Medicare covers you.

What can you do about the IRMAA adjustments?

A close-up shot of an older man with gray hair and a beard, wearing a light blue shirt, looking distressed and holding his temples with his hands. In the blurred background, blue-tinted documents are visible, including a 'MEDICARE HEALTH' form with 'JOHN DOE' and text about 'NEUTROPHILS', alongside a prescription bottle label showing 'MEDICATION QTY: 20' and 'Refills'.

If you are subject to these adjustments to Medicare premiums because of your income, there’s not much you can do.

Your best bet is try to avoid having this happen in the first place by considering investing for retirement in a Roth IRA or 401(k) instead of a traditional account, and being careful about how large your withdrawals are or when you sell assets to limit capital gains.

A financial advisor can help you make a strategic plan to try to help you avoid sending your Medicare premiums skyrocketing, so you can keep more of your hard-earned funds in your accounts instead of sending extra money to Medicare.

Medicare Supplement Plan G: Your Guide to “Zero-Surprise” Healthcare

Andy |

Original Medicare (Parts A and B) is a great start, but it leaves significant “gaps”—like the 20% coinsurance you pay for doctor visits and hospital stays. Medigap Plan G is designed to step in and pay those bills for you, providing the most comprehensive coverage available to new Medicare members today.

How Plan G Works

Think of Plan G as a “shield” for your savings. Once you pay one small annual deductible, your plan takes over 100% of your Medicare-approved medical bills.

  1. You pay the Part B Deductible: In 2026, this is $283 for the entire year.
  2. Plan G pays the rest: After that first $283, you pay $0 for Medicare-approved doctor visits, surgeries, lab work, and hospital stays.
  3. Freedom of Choice: You can see any doctor in the U.S. who accepts Medicare. No networks, no referrals, and no “prior authorizations” required.

Why Plan G is Your Best Option

While other plans exist, Plan G remains the “Gold Standard” for three reasons:

The Hazard of Waiting: Why Now is the Best Time

There is a “Golden Window” to buy a Medigap plan, and missing it can be a costly mistake.

CONTINUED ON NEXT PAGE

Plan G vs. The Alternatives

Feature Medigap Plan G Medicare Advantage
Doctor Choice Any doctor in the U.S. Limited Network (HMO/PPO)
Referrals Never needed Usually required for specialists
Out-of-Pocket Costs $283 annual max Up to $9,000+ per year
Predictability High (Flat monthly premium) Low (Pay-as-you-go copays)

The Bottom Line: If you want the freedom to choose your own doctors and the security of knowing exactly what your healthcare will cost each year, Plan G is the smartest choice for your retirement.

If you have a home in Arizona and would like a quote or have questions on Medicare Plan G we can help!

Andy Orlikoff

American Insurance Benefits

www.AZhealth.us

623-742-3878

The Great Medicare U-Turn: How to Switch Back to Original Medicare

Andy |

The Great Medicare U-Turn: How to Switch Back to Original Medicare

If you’ve spent the last year realizing that “Advantage” doesn’t always feel like an advantage, you aren’t alone. Maybe your favorite specialist left the network, or you’re tired of asking for “prior authorization” just to get an MRI.

The good news? If you’re reading this in January, the door is wide open for a change. But before you jump ship, there’s a specific sequence you need to follow to avoid getting stranded without coverage.

1. The “Right Now” Window: The 2026 MA OEP

Since today is January 26, 2026, you are currently in the Medicare Advantage Open Enrollment Period (MA OEP). This runs from January 1 to March 31. The Fall Window: Annual Enrollment Period (AEP) Dates: October 15 – December 7.

During this time, you can:

Note: If you make the switch this month, your new coverage will typically begin on the 1st of the following month.

2. The Medigap “Trap”: Don’t Drop Your Plan Yet!

This is the most critical part of the U-turn. Unlike Medicare Advantage, which must take you regardless of health, Medigap (Medicare Supplement) providers in most states can use medical underwriting.

The Risk: If you have a pre-existing condition, a Medigap insurer can charge you more or deny you a policy entirely unless you have a “Guaranteed Issue Right.”

Do you have a “Guaranteed Issue Right”?

You generally don’t need a health screening if:

The Golden Rule: Secure your Medigap policy and get an acceptance letter before you officially disenroll from your Medicare Advantage plan.

3. Your 2026 Transition Checklist

Switching back involves a three-step dance. If you miss a step, you could face lifetime penalties or massive bills.

Step Action Why it matters
Step 1 Apply for Medigap Ensures your “gap” coverage is locked in before you leave your current plan.
Step 2 Join a Part D Plan Medicare Advantage usually includes drugs; Original Medicare does not. Missing this causes a late-enrollment penalty.
Step 3 Confirm Disenrollment Joining a standalone Part D plan usually automatically triggers your exit from Medicare Advantage, but always call your plan to confirm.

4. What Original Medicare Costs in 2026

Since you’re moving back to the “Original” way of doing things, here is a quick look at the 2026 rates:

Why People are Making the Switch

In 2026, the maximum out-of-pocket (MOOP) for Medicare Advantage plans can be as high as $9,250. For someone facing a major surgery or chronic illness, that “low premium” plan can suddenly become very expensive. Medigap Plan G, by contrast, covers nearly everything after you pay the small Part B deductible, giving you total “cost predictability.”

#healthinsurance #medicare #medigap #medicareadvantage #surprise, AZ #Sun City, AZ

Call Now Get a Quote