With over two decades working in Medicare policy, I’ve seen firsthand how legislation, corporate interests, and beneficiary assumptions can lead to significant gaps in care and financial burdens. Every year, I hear a common refrain from seniors: “I wish someone had told me this before I picked my plan.”

This article is the conversation I wish every new Medicare beneficiary could have before choosing between Original Medicare and Medicare Advantage (MA). Let’s dive into the hidden realities many only discover when it’s too late.

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1. The Hidden Cost of “Free”: Prior Authorization and Denied Care

Medicare Advantage plans often promote low or $0 monthly premiums, which sounds like a great deal on the surface. But behind that affordability lies a managed care structure built on cost containment — not always on patient-centered care.

Most MA plans are either HMOs (Health Maintenance Organizations) or PPOs (Preferred Provider Organizations), both of which often require prior authorization for services that would be covered automatically under Original Medicare.

A 2022 federal audit of MA plans found that 13% of denied services would have met Medicare’s coverage requirements. This means beneficiaries are sometimes denied medically necessary care, not because it’s inappropriate or excessive, but because the insurer wants to reduce costs. This can lead to:

• Delays in treatment
• Denial of critical services
• Frustration and confusion for patients and families

In contrast, Original Medicare rarely requires prior authorization, giving patients and doctors greater freedom to proceed with appropriate care without bureaucratic obstacles.

2. Narrow Provider Networks — and Surprise Changes

Another hidden downside of Medicare Advantage plans is the restricted provider network. You may choose a plan because your preferred doctor or hospital is in-network, only to find out a few months later that they’ve been dropped from the network. These changes can happen annually, and insurers are not required to maintain consistency year-to-year.

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This can lead to:

• Needing to change providers mid-treatment
• Losing access to trusted specialists
• Travel limitations (especially for snowbirds or frequent travelers)

With Original Medicare, you can see any provider nationwide who accepts Medicare — no networks, no referrals, and fewer surprises.

3. Medigap Is Not Always Guaranteed Later

A common misconception is that beneficiaries can start with a Medicare Advantage plan and, if they become dissatisfied, switch to Original Medicare + Medigap later.

While switching to Original Medicare is always allowed during Open Enrollment, Medigap (the supplemental insurance that helps cover out-of-pocket costs) doesn’t have the same guarantee. Outside of your six-month Medigap Open Enrollment Period (which starts when you first enroll in Part B), insurers in most states can deny you coverage or charge higher premiums based on your health status.

So, if your health deteriorates — which is common with age — and you want to leave MA for better flexibility and provider access, you may find yourself unable to qualify for an affordable Medigap plan.

This is a crucial point: The longer you wait, the more limited your options may become.

4. Total Costs Over Time: Advantage Isn’t Always a Bargain

Many seniors are drawn to Medicare Advantage plans because of the low or $0 monthly premiums. However, those plans often include copays for nearly every service and higher out-of-pocket maximums.

For 2025, the maximum in-network out-of-pocket limit for MA plans is $8,850. And that doesn’t account for potential out-of-network charges, travel restrictions, or referral delays for specialists.

Original Medicare combined with Medigap and Part D may cost more up front, but it provides:

• Predictable costs
• Lower out-of-pocket exposure
• Freedom to access care nationwide

If you or a loved one has chronic conditions, sees multiple specialists, or wants peace of mind when traveling, Original Medicare + Medigap may actually result in better coverage and lower total expenses over time.

5. Don’t Be Distracted by Perks

Medicare Advantage plans often advertise perks like:

• Gym memberships
• Vision exams
• Hearing aid discounts
• Dental cleanings

These extras can be helpful, but they are not a substitute for robust, unrestricted access to medical care.

Unfortunately, many beneficiaries make plan choices based on these perks rather than core health benefits. While a free fitness class or discounted eyeglasses may sound appealing, they don’t make up for denied care, narrow networks, or costly referrals.

Focus on coverage for the “what-ifs” — not the add-ons.

6. Prescription Drug Coverage and Gaps

It’s important to understand that Original Medicare does not cover prescription drugs. If you opt for Original Medicare + Medigap, you’ll also need a separate Part D plan for drug coverage.

Medicare Advantage plans often include drug coverage (MAPD plans), which is more convenient but comes with its own set of limitations:

• Formularies (drug lists) that change annually
• Tiered copay systems
• Step therapy and prior authorization for certain medications

Whether you choose Part D or MA with drug coverage, make sure the medications you need are covered. Use the Medicare Plan Finder tool to compare plans based on your actual prescriptions.

7. Emergency and Travel Considerations

Original Medicare offers nationwide coverage, which is critical for:

• Snowbirds who live in different states throughout the year
• Seniors who travel to visit family
• Emergency care when away from home

Medicare Advantage plans often restrict coverage to local or regional networks, meaning that even if you have an emergency in another state, your plan may not cover it, or you may be charged out-of-network rates.

8. Administrative Hurdles and Frustration

Many seniors with Medicare Advantage report confusion and delays caused by:

• Denied claims
• Required referrals
• Long phone wait times
• Coordination of care breakdowns

This administrative burden can be especially difficult for older adults managing multiple conditions or cognitive impairments.

Original Medicare, by contrast, is straightforward. Providers bill Medicare directly, and Medigap picks up the balance (depending on your plan).

9. Medicare Advantage Works for Some — But Not Everyone

To be fair, Medicare Advantage is not inherently bad. For some beneficiaries, it can be a good fit:

• If you’re relatively healthy
• If your doctors are all in-network
• If you live in one area year-round
• If you prefer lower monthly premiums and can tolerate higher cost-sharing

In these cases, MA plans may provide affordable and streamlined coverage.

But if you prioritize:

• Freedom to choose providers
• Predictable, lower long-term costs
• Stability as your health needs change
• Fewer administrative obstacles

Then Original Medicare + Medigap remains the gold standard for comprehensive coverage.

10. Final Advice: Choose Carefully, and Early

The most important step you can take is to educate yourself before your Medigap Open Enrollment Period ends. Once that window closes, your future options may be limited.

Here’s what to do:

• Use www.medicare.gov to compare plans based on your doctors, prescriptions, and location
• Call your local SHIP (State Health Insurance Assistance Program) for free, unbiased help
• Don’t rely solely on TV commercials or sales agents
• Ask your current providers which plans they accept
• Consider your long-term health, not just today’s budget

Conclusion: What Most People Regret

Most regrets about Medicare Advantage come too late — after care is denied, a doctor is dropped, or out-of-pocket costs become overwhelming.

What you save in monthly premiums could cost you thousands in the long run — or worse, limit your access to care when you need it most.

Don’t choose a plan because it’s marketed as “free.” Choose a plan because it provides the care you need, when and where you need it.

Medicare is complicated. But the consequences of misunderstanding it are even more so. Make an informed choice now — your future self will thank you.