6 Medicare Advantage Disadvantages Worth Knowing Before 2027
Medicare Advantage plans get marketed hard every fall. Zero-dollar premiums, dental, vision, gym memberships — the commercials make it sound like a no-brainer. And for some people, it works out fine.
But going into 2027, the ground is shifting. CMS finalized its 2027 payment rates for these plans: a 2.48% net increase, which works out to about 5% once expected risk-score trends are included. Insurers say even that isn’t keeping pace with what care actually costs — Humana has already told investors it plans to adjust benefits where necessary next year. When money gets tight, benefits are usually where it shows. (For balance: CMS says about 8 in 10 MA enrollees can keep their current plan at the same or a lower premium in 2027, with average premiums ticking down slightly.)
I don’t sell Medicare Advantage, and I’ve put my reasons in writing. But whether you work with me or not, here are six Medicare Advantage disadvantages worth knowing before the year turns.
1. Prior authorization can delay the care you need
Original Medicare has historically made you ask permission far less often than Advantage plans do. A 2026 report from the HHS Office of Inspector General looked at skilled nursing facility admission requests from June 2024, across 19 parent companies covering about 86% of MA enrollment. Plans denied 12% of those requests — and when patients or providers appealed, the plans overturned 95% of the denials. The OIG’s read: some enrollees were initially denied care that was medically necessary. One detail that sharpens the point: only about 18% of those denials were ever appealed. Appeals take time, and if you’re recovering from surgery or a hospital stay, time matters.
One caveat, especially here in Arizona: starting in 2026, CMS began testing prior authorization inside Original Medicare itself, under a pilot called WISeR. It covers six states including ours, and a defined set of outpatient services — narrower than what Advantage plans do, but the line isn’t as clean as it used to be. A Medigap policy doesn’t change that part.
2. Networks decide where you can go
Original Medicare lets you see just about any doctor or hospital in the country that takes Medicare. (For perspective: KFF found Advantage plans included just under half — 48% — of the physicians available to traditional Medicare beneficiaries.) Medicare Advantage HMOs generally require you to stay in-network except for emergencies; PPOs give you some out-of-network coverage, but you’ll pay more for it.
That’s manageable until your longtime specialist leaves the network — and network limits are among the most common Medicare Advantage disadvantages I hear about — or the hospital you trust isn’t covered anymore. It hits harder outside the cities: in 2026, KFF found beneficiaries in the most rural counties had about 20 plans to choose from on average, versus 42 in urban areas — and KFF’s 2027 data shows options shrinking again, with the average beneficiary seeing 28 drug-included plans, down from 32.
3. The low premium and extra perks can shrink
That $0 premium and the dental, vision, and over-the-counter allowances reset every year. Plans can raise premiums, increase copays, and trim supplemental benefits each January. Going into 2027, with insurers openly planning benefit adjustments, the plan that worked great this year can look very different next January — more expensive, less generous, or both.
4. Your drug coverage can change under you
Most Medicare Advantage plans bundle in Part D drug coverage, and formularies, pharmacy networks, and coverage rules can all change annually. A medication can move to a higher cost tier or pick up new restrictions in the new plan year. Checking that your premium didn’t change isn’t enough — run every regular prescription through Medicare’s Plan Finder tool before you renew.
5. Your plan can disappear entirely
Sometimes the change is bigger than a benefit tweak: an insurer can drop a specific plan or leave your county altogether. When a plan’s contract actually ends and you don’t pick another Advantage plan, you’re generally moved to Original Medicare — and that move comes with a 63-day window where you have a federal guaranteed right to buy certain Medigap policies. That protection doesn’t apply if your plan was merely consolidated into another one of the insurer’s plans, so it matters which kind of change you’re dealing with.
Either way, it can be genuinely disruptive if you’re in the middle of cancer treatment, rehab, or another complex course of care. New plan, new doctors, new pharmacies, new copays.
6. Getting back to Original Medicare can be harder than leaving was
This is the one people miss. You can leave Medicare Advantage and return to Original Medicare during an enrollment period — but that doesn’t automatically mean you can buy a Medigap policy to cover Original Medicare’s deductibles and coinsurance. Outside your six-month Medigap open enrollment window or a guaranteed-issue situation, insurers in most states can charge you more or deny you based on your health.
Two exceptions worth knowing. First, the trial right: if you joined Medicare Advantage when you first became eligible and leave within the first year, federal law gives you guaranteed-issue rights to buy a Medigap policy. Second, as noted above, if your Advantage plan’s contract ends or it stops serving your area, you generally get that 63-day guaranteed-issue window. But if you leave voluntarily while your plan keeps operating — and you’re past your trial year — you may not have that protection. (A few states are more protective than the federal baseline, so this is a check-your-state situation.)
What to do about these Medicare Advantage disadvantages
I’m not telling you Medicare Advantage is never the right call. I’m telling you to go in with your eyes open — especially for 2027, with plan data already live and open enrollment underway.
Your Annual Notice of Change should have arrived by September 30. If you haven’t seen yours, call your plan. It spells out exactly what’s changing in January. Then check the things that actually matter to you: your doctors, your hospitals, your prescriptions, your premium, your maximum out-of-pocket, and those supplemental benefits. Don’t assume this year’s coverage carries forward unchanged.
And if you’d rather have coverage built for stability — standardized Medigap benefits that are guaranteed renewable, no networks, no disappearing plans — that’s exactly what I do — I help people compare these Medicare Advantage disadvantages against what a supplement offers. Two honest caveats: the standalone Part D drug plan you’d pair with Medigap does change yearly (options are shrinking for 2027, and some buyers face steep premium jumps), and Medigap premiums themselves can rise over time. But the core medical coverage doesn’t reset every January. I’ve explained my thinking here: why I don’t sell Medicare Advantage.
Medicare open enrollment runs October 15 through December 7. If you want a straight answer about what your options actually look like, call or text me at (623) 742-3878. I’ll run your numbers free.
Medicare Open Enrollment 2027 Arizona officially opens October 15 and runs through December 7 — seven weeks to review your coverage and make changes for next year. But the window itself isn’t the hard part; the hard part is the stack of notices that show up beforehand, which most people skim past without realizing what each one is actually telling them.
Choosing Medicare Advantage at 65 feels like a low-risk decision, especially with a low or zero monthly premium. The catch tends to show up years later: going from Medicare Advantage to Medigap can be much harder than getting into Medicare Advantage ever was. That’s worth knowing this fall, with Medicare’s Annual Election Period running October 15 through December 7.
