Healthcare workers have long been outspoken about Medicare Advantage problems — and a viral TikTok video from nurse Christy (@christyprn) brought those concerns to a mainstream audience. Her message, viewed over 128,000 times: don’t enroll in Medicare Advantage plans. Here’s why healthcare professionals feel so strongly about this issue, and what it means for Arizona seniors.
What Healthcare Workers Say About Medicare Advantage Problems
Christy’s video resonated because it confirmed what many nurses, doctors, and hospital administrators see daily. As she explained: “A lot of health care workers really don’t like these Medicare Advantage plans because they tend to deny a lot of really important care that traditional Medicare would have covered.”
The comments section lit up with healthcare workers sharing their own experiences:
“I work in outpatient care, and the Medicare Advantage plans are the worst. We can’t get anything covered.”
“RN here. Amen sister. It will bankrupt them.”
“Thank you, say it louder. Advantage plans are thieves.”
These aren’t random opinions — they’re frontline observations from people who see Medicare Advantage prior authorization denials, network restrictions, and coverage gaps affect patient care every day.
The Core Medicare Advantage Problem: Prior Authorization
The primary complaint from healthcare workers is prior authorization — the process where a Medicare Advantage plan must approve care before it’s delivered. According to Kaiser Family Foundation research, virtually all Medicare Advantage enrollees (99%) are in plans that require prior authorization for at least some services.
When authorization is denied, patients face delays or must pay out of pocket. Original Medicare does not require prior authorization for most services — your doctor’s recommendation is enough.
Why Medicare Advantage Problems Hit Hardest When You Need Care Most
Medicare Advantage plans often look attractive at enrollment — low or zero premiums, extra benefits like dental and vision. The Medicare Advantage problems tend to surface later, when you actually need serious medical care:
Hospital admissions requiring prior authorization
Skilled nursing facility stays cut short by plan decisions
Specialist referrals delayed or denied
Out-of-network care at full cost when traveling or seeing specialists
What the Alternative Looks Like
Original Medicare with a Medicare Supplement Plan G works completely differently. Once you pay the annual Part B deductible ($257 in 2026), Medicare and Plan G cover your costs for the year — no prior authorization, no networks, no annual benefit changes.
That’s why nurses, doctors, and other healthcare professionals — who understand the system from the inside — consistently choose Original Medicare for themselves and their families when given the choice.
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 avoid Medicare Advantage problems by choosing coverage that works when they need it most.
When you turn 65, the biggest Medicare decision you’ll face is this: Original Medicare vs Medicare Advantage — which one is right for you? The differences are significant, and one expert says one of those options is clearly the worse choice for most seniors. Here’s the full breakdown.
As you approach age 65, you’ll have some decisions to make about medical coverage. On one hand, you can enroll in Medicare. But you may be tempted to choose another option instead: a Medicare Advantage (MA) plan instead. If you’ve seen the advertisements for MA plans, you might think they’re more cost-effective and comprehensive than Medicare. But according to Keith Armbrecht, Founder of Medicare education company, Medicare on Video, that’s not necessarily true.
“I would never choose a Medicare advantage plan,” he says in a YouTube video entitled “Why Medicare Advantage Is The Worst Choice For Seniors.”
Here’s why he’s not a fan of these plans.
What is a Medicare Advantage plan?
Medicare Advantage plans are alternative insurance plans to Medicare, and they’re offered by Medicare-approved private companies. These plans are sometimes called “Part C” or “MA,” and they include Medicare Part A (hospital insurance) and Part B (medical insurance).
Those interested in MA have more than 40 different plans to choose from. The main
reasons to explore them include:
The potential for lower premiums compared to Medicare. In 2022, the average premium was $58, according to 2022 data from the U.S. Senate Committee on Finance.
Out-of-pocket costs may be capped. In 2023, the maximum was $8,300 for approved services.
Most plans include dental, vision, hearing and fitness benefits.
That being said, there are a few downsides to Medicare Advantage plans. Here are some important things to consider before locking into an MA plan.
Limited choice
If you opt for an MA plan, your choice of doctors can be limited and you’re likely to face obstacles in getting approved for procedures or seeing specialists. “The primary reason I would absolutely choose original Medicare and would never choose Medicare Advantage is because I want control over what I do,” says Armbrecht. With an MA plan, he warns, you can face wait times of “weeks, even months,” to get referrals or have procedures authorized.
You’re typically limited to doctors in the plan network and service area, as well,
according to the government’s Medicare website.
Deceptive marketing
The Medicare Advantage plan industry has a history of deceptive practices. In 2022, the Majority Staff of the U.S. Senate Committee on Finance found that Medicare beneficiaries were being inundated with aggressive marketing tactics, false and misleading information and overall predatory marketing from MA providers. According to the report, deceptive Medicare Advantage marketing practices are, “widespread, not isolated events.”
According to a 2022 review from the New York Times, four out of five of the largest MA providers (UnitedHealth, Humana, Elevance and Kaiser) have faced federal lawsuits for fraud and at least eight providers overbilled, according to the U.S. Department of Health and Human Services Office of the Inspector General.
Denied claims
Multiple studies have shown MA plans have a pattern of denying claims that should be covered.
A 2022 review from the Inspector General’s office found that MAs denied 13% of prior authorization requests that met Medicare coverage rules. Essentially, these claims would have been approved under original Medicare. The most commonly denied requests were imaging services, stays in post-acute facilities and injections.
Go to the source
“Medicare is probably the only government program that does exactly what it’s supposed to do and does it very well,” says Armbrecht. In other words, original Medicare is likely your best choice. If you’re nearing 65 and considering your options, you can visit Medicare.Gov for accurate and up-to-date information so you can make the right decision for your health insurance needs.
For most Arizona seniors, Original Medicare with Plan G provides better protection when you need care most. Call Andy Orlikoff at (623) 742-3878 for a free, no-pressure comparison.
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.
1. It has a much smaller healthcare provider network
Most — though not all — American healthcare 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 maintain your current doctor then it could eliminate a lot of money 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.
2. 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.
3. 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.
4. It usually requires referrals to see specialists
With Original Medicare, you can schedule a specialist visit even without a referral. With Medicare Advantage, though, you can’t simply call a specialist and schedule an appointment. Instead, you need a referral from a primary healthcare 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.
5. It requires preauthorization for most high-cost services
If you’re enrolled in Medicare Advantage, you’ll likely end up paying for some of the most expensive healthcare services out of pocket unless you get the expense pre-approved.
Those services include inpatient hospital stays, partial hospitalizations, physical therapy, dialysis, hearing exams, psychiatric services, and much more.
If you don’t get the expense approved in advance, you’ll likely end up paying for it out of pocket. For the most part, Original Medicare doesn’t require preauthorization.
6. 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.
7. 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.
8. 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.
9. It can make budgeting for healthcare even harder
Since you can’t always anticipate your health needs in advance, budgeting for healthcare is notoriously tricky. If you’re living on a fixed income, though, you need to carefully track your expenses to make sure you don’t overspend.
Original Medicare makes healthcare expenses easier to anticipate by charging you a recurring monthly premium. As a result, you can then visit a healthcare provider at a lower cost and without rearranging your budget to accommodate the additional expense.
In contrast, most Medicare Advantage plans don’t have a monthly premium. Instead, you pay for medical expenses out of pocket until you hit your out-of-pocket max, which makes it hard to know how much you could be spending on healthcare in a given month.
Bottom line
Medicare Advantage plans can offer crucial benefits that make life easier for some retirees, especially those in good health with relatively few healthcare needs.
But it’s definitely not the right choice for everyone. You should weigh the pros and cons with 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 to prevent the need to make extra money for insurance.
If you’re enrolled in a Medicare Advantage plan, you may face a frustrating reality: your doctor orders care, but your insurance company can say no. Medicare Advantage prior authorization denials are far more common than most seniors realize — and a landmark Kaiser Family Foundation study puts the numbers in stark perspective.
Medicare Advantage Prior Authorization Denials by the Numbers
Of the 35 million prior authorization requests submitted by Medicare Advantage enrollees in 2021, two million were fully or partially denied — according to a KFF analysis of data from 515 Medicare Advantage contracts covering 23 million enrollees.
That’s a significant portion of requests for care that a doctor deemed medically necessary, denied by an insurance company’s approval process.
Even more telling: the study found a high frequency of favorable outcomes on appeal. As KFF researchers noted, this raises questions about “whether a larger share of initial determinations should have been approved” in the first place.
Why Medicare Advantage Prior Authorization Is a Problem
In 2022, virtually all Medicare Advantage enrollees (99%) were in a plan that required prior authorization for at least some services. High-cost services most commonly subject to Medicare Advantage prior authorization include:
Chemotherapy
Skilled nursing facility stays
Inpatient hospital admissions
Durable medical equipment
Specialist referrals
When a prior authorization is denied, patients face a choice: appeal the decision (which takes time), pay out of pocket, or go without the care their doctor recommended. According to KFF’s research, many patients simply give up after a denial rather than navigating the appeals process.
Original Medicare Doesn’t Have This Problem
Original Medicare does not require prior authorization for most services. If Medicare covers a service and your doctor orders it, it’s covered — no approval process, no delay, no denial.
With a Medicare Supplement Plan G, your share of costs is zero after the Part B deductible. No network restrictions, no prior authorization, no insurance company overruling your doctor.
Questions About Your Medicare Options in Arizona?
I’m Andy Orlikoff, an independent Medicare broker in Surprise, AZ. I help Arizona seniors understand Medicare Advantage prior authorization risks and whether Original Medicare with Plan G is a better fit. My help costs nothing extra.
