Medicare Advantage plans — also called Medicare Part C — are heavily marketed to Arizona seniors every fall. The ads make them sound like a no-brainer — low premiums, extra benefits, simple coverage. However, after more than 20 years helping Arizona residents navigate Medicare, I’ve seen the disadvantages of Medicare Advantage plans up close. Here are 9 things the ads don’t tell you.
1. Disadvantages of Medicare Advantage: Narrow Provider Networks
One of the biggest disadvantages of Medicare Advantage is the restricted network. Most plans only cover care from in-network providers. If your doctor isn’t in the plan’s network, you pay out-of-pocket — or find a new doctor.
Original Medicare lets you see any doctor in the U.S. who accepts Medicare. That’s the vast majority of physicians. Medicare Advantage plans can’t say the same.
2. Prior Authorization Requirements
Before Medicare Advantage pays for many procedures, the insurance company must approve them first. This process — called prior authorization — can delay care by days or weeks. In some cases, approval is denied entirely.
According to Medicare.gov, Original Medicare does not require prior authorization for most services. Your doctor decides what care you need, and Medicare covers it.
3. Higher Out-of-Pocket Costs When You’re Sick
Medicare Advantage plans often advertise low or zero premiums. However, when you actually use the plan, costs can add up quickly. Copays for specialist visits, hospital stays, and procedures can push your annual out-of-pocket costs to $8,000–$10,000 or more.
With a Medicare Supplement (Medigap) Plan G, your only cost is the Part B deductible — $283 in 2026. After that, you pay nothing for covered services the rest of the year.
4. Plans Change Every Year
Medicare Advantage plans can change their benefits, networks, copays, and drug formularies every January 1st. A plan that worked well for you in 2025 may look very different in 2026. Your doctors may drop out of the network. Your medications may no longer be covered at the same cost.
Medigap plans are standardized and stable. Plan G benefits are set by the federal government and don’t change from year to year.
5. The One-Way Door Problem
This is the most serious of all disadvantages of Medicare Advantage that most people don’t discover until it’s too late. If you enroll in Medicare Advantage and later want to switch to a Medigap supplement plan, you may need to pass medical underwriting.
Insurance companies can deny you Medigap coverage — or charge significantly higher premiums — based on your health history. Once you’re locked into Medicare Advantage with serious health conditions, switching may no longer be possible.
6. Limited or No Coverage Outside Your Service Area
Most Medicare Advantage plans only cover non-emergency care within their local service area. If you travel frequently, spend time in another state seasonally, or want access to specialists in other cities, Medicare Advantage can leave you uncovered.
Original Medicare — and any Medigap plan — covers you at any Medicare-accepting provider nationwide. No zip code restrictions.
7. Mayo Clinic and Major Hospitals Often Not Included
Mayo Clinic Arizona does not accept most Medicare Advantage plans. Neither do many other major specialty hospitals. If you’re diagnosed with a serious condition and want access to the best specialists in the country, Medicare Advantage may not get you there.
Original Medicare is accepted at Mayo Clinic and most major medical centers across the U.S.
8. “Extra Benefits” Are Often Overstated
Medicare Advantage plans advertise dental, vision, hearing, gym memberships, and other extras. In practice, these benefits are often limited — small dollar amounts for dental, narrow networks for vision, or gym programs that require specific facilities.
Many people find these add-ons don’t offset the higher costs they face when they need real medical care.
9. Smaller Networks in Rural Arizona
If you live outside the Phoenix metro — in rural Arizona, smaller cities, or communities far from major medical centers — Medicare Advantage networks may offer very few in-network options. Driving long distances to see an in-network provider, or paying out-of-network rates, becomes a regular reality.
Original Medicare works everywhere there’s a Medicare-accepting doctor. In rural areas, that’s often the only practical choice.
What to Consider Instead of Medicare Advantage
Understanding the disadvantages of Medicare Advantage before you enroll can save you from a very difficult situation down the road.
I’m Andy Orlikoff, an independent Medicare broker based in Surprise, AZ. I don’t sell Medicare Advantage. After 20+ years watching what happens when people need their coverage most, I recommend Medicare Supplement Plan G to nearly every client who qualifies.
I’ll compare rates from multiple carriers, explain your options clearly, and help you enroll — at no cost to you. Your premium is the same whether you use a broker or go direct.
As an independent insurance broker helping Arizona retirees since 2004, I’m seeing a clear pattern this year: more people are asking whether they should stay with Medicare Advantage or switch to something better. After reviewing what’s happening with Advantage plans in 2026, I’m recommending Medicare Supplement Plan G to virtually every client who qualifies. Here’s why.
Why I’m Recommending Medicare Supplement Plan G in 2026
Medicare Advantage plans have been losing ground. In 2026, several major carriers cut benefits, raised copays, and reduced networks. According to Medicare.gov, you can switch plans during open enrollment if yours no longer works for you. A JAMA study found that 1 in 10 Medicare Advantage members was forced off their plan entirely. Meanwhile, Medicare Supplement Plan G hasn’t changed — and that stability is exactly what my clients need.
No Prior Authorization With Medicare Supplement Plan G
One of the biggest frustrations I hear from clients on Medicare Advantage is prior authorization. Before you can have a procedure, the insurance company has to approve it. That approval can take days or weeks — and it can be denied.
With Medicare Supplement Plan G, there is no prior authorization. If Medicare covers a service, Plan G pays. The decision stays between you and your doctor, not an insurance company’s claims department.
See Any Doctor in Arizona — and Across the Country
Medicare Advantage plans restrict you to a network. Step outside it and you pay out-of-pocket — or you’re not covered at all.
Medicare Supplement Plan G works with Original Medicare, which means you can see any doctor in the U.S. who accepts Medicare. In Arizona, that matters for a few specific reasons:
Mayo Clinic Scottsdale accepts Original Medicare — and therefore Plan G. Most Medicare Advantage plans are not accepted at Mayo Clinic.
Snowbird protection — many Arizona clients split time between states. Plan G covers you wherever Medicare is accepted. Your Advantage plan likely doesn’t.
No referrals required — you can see a specialist directly, without waiting for a primary care gatekeeper.
Predictable Costs All Year
Medicare Advantage plans advertise low or zero premiums. However, the real costs show up in copays, coinsurance, and out-of-pocket maximums that can reach $8,000–$10,000 per year if you get seriously ill.
With Medicare Supplement Plan G, your only out-of-pocket cost is the Part B deductible — $283 in 2026. After that, you pay nothing for covered services for the rest of the year. No surprise bills. No anxiety about what the mail brings after a hospital stay.
Plan G Rates in Arizona — What to Expect in 2026
Plan G premiums vary by age and carrier. However, as a general benchmark for Arizona:
Age 65: approximately $100–$150/month
Age 70: approximately $130–$190/month
Age 75: approximately $160–$230/month
Rates for the same plan vary significantly between carriers. As a result, comparing quotes from multiple companies before you enroll can save you $50–$100 per month — with identical benefits. That’s exactly what I do for every client.
The One-Way Door: Why Timing Matters
Here’s what most people don’t know: if you enroll in Medicare Advantage and later want to switch to Medicare Supplement Plan G, you may need to pass medical underwriting. That means insurance companies can deny you or charge more based on your health history.
When you first turn 65 and enroll in Medicare Part B, you have a 6-month open enrollment window where no company can deny you Plan G regardless of health. That window only happens once. After it closes, switching becomes much harder — and sometimes impossible.
If you’re turning 65 or newly enrolled in Medicare, get Plan G in place now, while the door is open.
Ready to Talk About Plan G for 2026?
I’m Andy Orlikoff, an independent Medicare broker based in Surprise, AZ. I don’t sell Medicare Advantage — and I’ll tell you exactly why when we talk. I work with multiple carriers and find the lowest rate for Medicare Supplement Plan G that fits your situation.
Serving Phoenix, Scottsdale, Peoria, Glendale, Surprise, Mesa, Chandler, Gilbert, Goodyear, Tucson, Sun City, and all of Arizona.
The federal government’s approach to Medicare Advantage payment rates has become a major issue for Arizona seniors. Proposed flat funding rates — where the government pays insurers a fixed amount regardless of rising healthcare costs — could trigger significant changes to Medicare Advantage plans starting in 2027. Here’s what’s happening and what it could mean for your coverage.
What Are Medicare Advantage Payment Rates?
The federal government pays private insurance companies a set amount per enrollee to administer Medicare Advantage plans. These Medicare Advantage payment rates are set annually by the Centers for Medicare and Medicaid Services (CMS). The payment amount affects how much margin insurers have — which in turn affects the benefits, networks, and premiums they can offer enrollees.
According to CMS, the 2027 advance notice proposed payment rates that alarmed many health insurers — at 0.09% growth, far below what insurers said they needed to keep pace with rising healthcare costs.
Why Flat Medicare Advantage Payment Rates Are a Problem
When Medicare Advantage payment rates don’t keep up with actual healthcare cost inflation, insurers face a choice: absorb losses, reduce benefits, raise copays, or exit markets. We’ve already seen this pattern play out:
UnitedHealthcare contracted its Medicare Advantage enrollment by over 1 million members
Humana, CVS Health’s Aetna, and Elevance Health pulled back from certain markets
Major insurers have reduced extra benefits like dental, vision, and OTC allowances
Some plans have increased copays and narrowed provider networks
If flat payment rates become the norm, these trends are likely to accelerate through 2027 and beyond.
What This Means for Arizona Medicare Advantage Enrollees
If you’re currently on a Medicare Advantage plan in Arizona, here’s the practical risk:
Your plan’s benefits could be reduced at the next Annual Enrollment Period
Your doctors or hospitals could leave the network
Your plan could exit the Arizona market entirely, forcing you to find a new plan
Copays and out-of-pocket maximums could increase
This isn’t speculation — it happened to over 1 in 10 Medicare Advantage members in 2026, who were forced off their plans when insurers withdrew from markets.
Why Medicare Supplement Plans Are Not Affected
This is a critical distinction. Medicare Advantage payment rates set by the government affect Medicare Advantage plans directly. Medicare Supplement (Medigap) Plan G operates completely differently.
Medigap plans work alongside Original Medicare. They don’t depend on government payment negotiations with private insurers. The benefits are standardized by federal law, your coverage doesn’t change annually, and your doctors don’t leave a “network” because there is no network. Plan G works with any doctor who accepts Medicare — and that’s the vast majority of physicians in Arizona.
Is This a Good Time to Reconsider Medicare Advantage?
If you’re still in your Medigap open enrollment window — the 6 months after you first enroll in Medicare Part B — you can switch to a Medicare Supplement plan without medical underwriting. That window is the most important decision point in your Medicare journey.
If you’ve already been on Medicare Advantage for more than a year, switching to Medigap may require medical underwriting. That means insurance companies can review your health history before approving you. It’s not impossible, but it’s harder — which is why acting early matters.
Questions About Your Medicare Options in Arizona?
I’m Andy Orlikoff, an independent Medicare broker in Surprise, AZ. I don’t sell Medicare Advantage. I help Arizona seniors understand how Medicare Advantage payment rates and policy changes could affect their coverage — and whether a Medicare Supplement plan is a better fit for their situation.
If you’ve spent the last year realizing that Medicare Advantage isn’t working for you — prior authorization denials, limited networks, surprise bills — you’re not alone. Thousands of Arizona seniors make the switch back to Original Medicare every year. In this guide, you’ll learn exactly how to switch from Medicare Advantage to Original Medicare, what windows are available, and what to watch out for.
Why People Switch from Medicare Advantage to Original Medicare
The most common reasons I hear from clients who want to switch from Medicare Advantage to Original Medicare:
Their doctor left the plan’s network
Prior authorization delays for procedures or specialists
Moving to a different part of Arizona or another state
Wanting access to Mayo Clinic or a major specialty hospital
High out-of-pocket costs after a serious illness
The plan’s benefits changed significantly at renewal
When Can You Switch from Medicare Advantage to Original Medicare?
There are two main windows to switch from Medicare Advantage to Original Medicare. Missing these windows means waiting until the next opportunity.
Medicare Advantage Open Enrollment Period (MA OEP)
January 1 – March 31 every year. During this window you can switch from one Medicare Advantage plan to another, or drop Medicare Advantage entirely and return to Original Medicare. Coverage changes take effect the first of the following month.
Annual Enrollment Period (AEP)
October 15 – December 7 every year. This is the main Medicare enrollment window. You can drop your Medicare Advantage plan and return to Original Medicare, with changes taking effect January 1. According to Medicare.gov, this is the primary window for making coverage changes.
The One-Way Door Problem: Medical Underwriting
Here’s the critical issue most people don’t know about when they try to switch from Medicare Advantage to Original Medicare: returning to Original Medicare is only half the equation.
Once you’re back on Original Medicare, you’ll want a Medicare Supplement (Medigap) Plan G to cover your out-of-pocket costs. But outside of your original 6-month Medigap open enrollment window, insurance companies can use medical underwriting — meaning they can deny you coverage or charge higher premiums based on your health history.
This is why I always tell clients: if you’re on Medicare Advantage and thinking about switching, do it sooner rather than later. The longer you wait, the more your health may change, and the harder it becomes to qualify for Medigap.
Special Enrollment Periods for Switching
In some situations you may qualify for a Special Enrollment Period (SEP) to switch from Medicare Advantage to Original Medicare outside the standard windows:
You moved out of your plan’s service area
Your plan is leaving the Medicare program
You qualify for Extra Help (Low Income Subsidy)
You were misled by your plan or agent
The Social Security Administration and Medicare handle these situations case by case. If you think you qualify, act quickly — SEP windows are typically 60 days.
Step-by-Step: How to Switch Back to Original Medicare
Confirm you’re in an eligible enrollment window (MA OEP, AEP, or SEP)
Contact your Medicare Advantage plan to disenroll — call the number on your plan card
Confirm your return to Original Medicare Parts A and B
Apply for a Medicare Supplement (Medigap) plan — do this simultaneously if possible
Sign up for a Part D prescription drug plan if you need one
Ready to Switch? I Can Help
I’m Andy Orlikoff, an independent Medicare broker in Surprise, AZ. I don’t sell Medicare Advantage — and I help Arizona seniors navigate the process to switch from Medicare Advantage to Original Medicare and get enrolled in the right Medigap plan. My help costs you nothing extra.
Every fall, millions of seniors face the same decision: Medigap vs Medicare Advantage — which is right for me? Despite Medicare Advantage’s heavy marketing, a significant number of seniors deliberately choose Medigap over Medicare Advantage. Here’s why.
The Core Reason Seniors Choose Medigap Over Medicare Advantage
The fundamental difference: Medicare Advantage is cheaper at enrollment but can cost far more when you’re sick. Medigap vs Medicare Advantage comes down to predictability. With Medigap Plan G, after the Part B deductible ($283 in 2026), you pay nothing for covered services all year. With Medicare Advantage, copays, coinsurance, and prior authorizations can add up to thousands.
Nurses, doctors, and hospital administrators — people who see how insurance affects patients — consistently prefer Medigap for themselves and their families. The reason: when a serious illness hits, Medicare Advantage plans frequently require prior authorization, restrict networks, and deny claims that Original Medicare would cover.
According to Medicare.gov, Medigap plans work alongside Original Medicare and cover most of the gaps Original Medicare leaves — without network restrictions or prior authorization requirements.
Five Reasons Seniors Choose Medigap Over Medicare Advantage
Any doctor, anywhere: Medigap works with any provider who accepts Medicare — no networks, no referrals
No prior authorization: Your doctor decides your care — not an insurance company algorithm
Mayo Clinic access: Mayo Clinic Arizona accepts Original Medicare and Medigap — not most Advantage plans
Predictable costs: One deductible per year, then nothing for covered services
Stable benefits: Medigap benefits don’t change annually — no ANOC to review every September
When Medicare Advantage Might Still Make Sense
If you can’t afford Medigap premiums or qualify for low-income assistance programs, Medicare Advantage may be your best available option. However, the one-way door risk remains: if you later want to choose Medigap over Medicare Advantage, you may need to pass medical underwriting.
Get a Free Comparison in Arizona
I’m Andy Orlikoff, an independent Medicare broker in Surprise, AZ. I help Arizona seniors understand the real Medigap vs Medicare Advantage tradeoffs — and I don’t sell Advantage plans.
