Don’t Choose a Medicare Advantage Plan Until You Read This: 5 Trade-Offs Few Discuss

Medicare Open Enrollment 2026 is currently underway, and odds are about even that you’ll enroll in a Medicare Advantage (MA) plan. According to independent research organization KFF, 54% of all Medicare beneficiaries are covered by this government-approved alternative to Original Medicare. Enrollment has grown steadily in recent years due to the plans’ low or $0 premiums and extra benefits.

Still, there are trade-offs to consider before settling on a choice for 2026. Don’t sign up for a Medicare Advantage plan until you’ve looked at the complete picture.

1. You’ll Have a Limited Provider Network.

Original Medicare is accepted by most hospitals and doctors in the U.S. Medicare Advantage plans, on the other hand, require policyholders to follow network rules that vary by plan type.

Health Maintenance Organizations (HMOs), for instance, typically only cover care from in-network providers (except for medical emergencies). Preferred Provider Organizations (PPOs) can cover out-of-network care, but at higher prices. Exclusive Provider Organizations (EPOs) fall somewhere in between the other two options, with larger networks than HMOs but still more restrictions than PPOs.    

If you choose a more restrictive MA plan, “you may lose access to physicians, clinics, and surgical centers near you,” said Jaime Mazur, who works with Medicare providers in her role as director of revenue cycle at Graymont Medical. 

2. You’ll Likely Need Authorization to Get Special Care

Medicare Advantage plans frequently require you to get prior authorization to see specialists, go out-of-network, receive non-emergency care at a hospital, take specialty medications, and more. That means you need to get permission from your insurer first, and there’s no guarantee it will approve the care. 

This requirement can leave you at risk of paying out of pocket if, for instance, you fail to get prior authorization before receiving treatment or are denied coverage but still choose to receive care because your doctor recommended it.

Prior authorization requirements can also delay treatment and services. However, beginning in January 2026, new federal rules require MA plan providers to make standard prior authorization decisions within 7 days and urgent decisions within 72 hours.  

3. MA Plans Can Be Affordable, But They’re Not Free

One of Medicare Advantage’s big selling points is that its plans, unlike Original Medicare, have annual out-of-pocket maximums (MOOPs). So, once you’ve paid a certain amount for care, you’ll pay $0 for covered services for the rest of the year. However, that doesn’t mean you won’t pay premiums, deductibles, copays, or coinsurance at all. 

Beneficiaries “often think that MA plans have coverage at 100% or act as a supplement to Medicare,” Mazur said. “They are surprised by out-of-pocket maximums and coinsurance amounts.”

Notably, MA plans often have two MOOPs: one for services and one for prescription drug coverage. (Medicare Part D drug costs, for instance, are capped to $2,100 in 2026.)

Plus, while many MA plans advertise $0 premiums, you’re still required to pay a monthly charge for Part B ($202.90 in 2026) and might have to pay a premium for Part D coverage if that’s not included in your MA plan.  

4. Switching Back to Original Medicare Could Cause Medigap Issues 

You can switch from Original Medicare to Medicare Advantage (and vice versa) during annual open enrollment between Nov. 1 and Dec. 7. 

You can also switch from an MA plan to Original Medicare during the annual Medicare Advantage Open Enrollment period that runs from Jan. 1 to March 31. 

While switching to Original Medicare is straightforward, you may encounter issues if you want a Medicare Supplement (Medigap) plan to help cover out-of-pocket costs under Original Medicare. That’s because, in most states, outside of specific protected periods, Medigap plans require medical underwriting—and an insurer can reject you or charge more for pre-existing health issues.    

Fortunately, there’s a bit of a buffer if you want to give Medicare Advantage a trial run. One of the protected periods includes the first year that you have an MA plan. You can switch back to Original Medicare and buy a Medigap plan, even with health issues, during this first year.

5. MA Plans Change Frequently & You May Have to Re-Shop for Coverage

Private insurance companies sell Medicare Advantage plans, and they’ll frequently adjust their offerings to address profitability issues. Those adjustments can include reduced benefits, network changes, revised drug formularies, and plan cancellations. When you sign up for a plan, it’s only a one-year commitment, and benefits could change dramatically in the following years. There’s also no guarantee your current MA plan will even exist in the future.           

This year, for instance, major insurers, including Aetna CVS Health, UnitedHealthcare, and Blue Cross Blue Shield, significantly reduced the number of MA plans and the markets in which they offered them, forcing many seniors to shop for new 2026 coverage. 

Deciding if an MA Plan Is Right for You

To determine whether an MA plan—and its tradeoffs—are worthwhile, take the following steps:

• Make sure your preferred providers are covered. “Consult the plan or offices of any current healthcare providers … to make sure that they are in network,” Mazur said. Otherwise, you’ll have to switch doctors or pay more for coverage.
• Check drug formularies to ensure the plan covers and charges affordable prices for the medications you’re on or expect to take in 2026.
• Compare all out-of-pocket expenses, including premiums, deductibles, copays, and coinsurance, across MA and Medigap plans. Don’t buy on premium alone, as other costs can add up quickly. 
• Reach out for help from a professional. If you’re having a hard time picking the best route for you, consult with a State Health Insurance Assistance Program (SHIP) counselor or licensed Medicare broker. They can walk you through the MA plans in your area.  

Curious about MA plans? See our picks for the best Medicare Advantage providers of 2026.