As a specialist in healthcare policy, I’ve gotten used to hearing from friends and colleagues when they or their parents become eligible for Medicare. That goes double this time of year, during open enrollment. The question I hear most frequently is simple: traditional Medicare or Medicare Advantage?
I tell them, and I’m telling you, what I told my dad when he turned 65: Friends and relatives don’t let friends and relatives sign up for Medicare Advantage. Medicare Disadvantage, as we wonks think of it, is a bargain that just might kill you.
Private Medicare Advantage plans promise freebies, like fancy gym memberships and preloaded debit cards, which make you think you’re getting a deal. But these plans are more likely than traditional Medicare to delay or deny coverage when enrollees advance from routine maintenance to serious illness.
Even if you can keep your doctor today, private Medicare Advantage plans frequently kick doctors and hospitals out of their networks.
A quick tutorial: Traditional Medicare, or Parts A and B, covers medical care, and the federal government pays doctors and hospitals directly. Medicare Advantage, or Part C, is supposed to cover the same services, but it’s run by private insurers that the government pays to manage your care.
To lure you away from traditional Medicare, these insurers dangle lower premiums and extra benefits — not only the gym membership and debit cards but also prescription drug coverage and dental, vision and hearing care. As a result, their plans seem cost-effective — no need for supplemental plans that cover prescription drugs and other benefits — and appeal to cash-strapped seniors living on a fixed income. This strategy is working: 55% of eligible Medicare beneficiaries are now enrolled in a private Medicare Advantage plan.
After these insurers overpromise coverage, they underdeliver.
First, they shrink your network. According to KFF, traditional Medicare patients can see virtually any nonpediatric physician — about 1 million in total — but the average Medicare Advantage plan limits patients to fewer than half that. This discrepancy means you might have to say goodbye to the doctor you’ve seen for years — or pay higher out-of-network rates to keep them.
Simply confirming whether a doctor is in network with your plan is often a costly and confusing challenge in its own right, as The New York Times reported earlier this month. And even if you can keep your doctor today, private Medicare Advantage plans frequently kick doctors and hospitals out of their networks, or providers leave for lack of a fair contract, further narrowing patients’ options.
Private insurers are happy to diagnose their Medicare Advantage customers with serious illnesses — as long as the insurers don’t actually need to treat those conditions.
Actually managing to see a doctor of your choice isn’t the only obstacle to care for Medicare Advantage enrollees. Private insurers abuse prior authorization requirements, where a provider must seek the insurer’s approval before treatment if they want a shot at being paid. Medicare Advantage plans requested prior authorization about 85 times more often per patient than traditional Medicare in 2024, according to KFF. The American Medical Association reports this additional paperwork means doctors and their staff spend, on average, 13 hours completing 39 prior authorization requests each week.
Congressional Democrats are also investigating UnitedHealth Group — the largest Medicare Advantage insurer — for allegedly paying nursing homes not to send patients enrolled in their plans to the hospital, even if they needed to go, as a cost-cutting measure. Two pending lawsuits and a complaint to New York state authorities tie those payments to three wrongful patient deaths. (In a statement to The Guardian, which broke the story, UnitedHealth denied engaging in any practices that “endanger patient safety or violate ethical standards” and denied that its employees prevented hospital transfers.) UnitedHealth Group, the parent company of UnitedHealthcare, reported nearly $13 billion in profit in 2025 and is on track to generate significantly more this year.
In addition, private insurers are happy to diagnose their Medicare Advantage customers with serious illnesses — as long as the insurers don’t actually need to treat those conditions. So, they “upcode,” a form of billing fraud that involves providers making questionable diagnoses so that patients appear sicker to juice federal payments, which are based on patients’ risk scores.
Because the largest insurers own providers, they can dispatch them, sometimes directly to patients’ homes, to do their bidding. Insurers market these visits at a perk, but they can leave patients with scary diagnoses — for diabetic cataracts, HIV, Parkinson’s disease or schizophrenia — and no corresponding treatment plan. According to MedPAC, federal overpayments related to upcoding total tens of billions of dollars annually, running up the deficit. Taxpayers foot the bill.
If Medicare Advantage plans are so bad, why are more than half of Medicare beneficiaries enrolled in one? Follow the money. Traditional Medicare has no profit motive and no marketing budget. But private insurers have deep pockets to pay agents and brokers to steer you toward their plans. That’s why I urged my dad to call his state health insurance assistance program for unbiased guidance.
He needed it, because enrolling in traditional Medicare is more complicated than it should be. Beyond Parts A and B, my dad has a private medigap plan, which covers his out-of-pocket costs for medical services, and a private Part D plan, which covers prescription drugs. That stack costs more than a single Medicare Advantage plan. Many older adults struggle to afford multiple premiums or are swayed by the gimmes.
I get the temptation — I live on a budget too — but Medicare Advantage is not worth the savings. These insurers routinely pull coverage, even for basic benefits, to pad their own profits. The burden of preauthorizations is so great that a growing number of providers, including entire hospital systems, no longer accept private Medicare Advantage plans. And private insurers face economic pressures that traditional Medicare does not. At least five insurers — including major player Humana — will exit the Medicare Advantage market at the end of this plan year, citing inadequate returns. Their patients are left scrambling.
Yes, switching from Medicare Advantage to traditional Medicare is common, especially when someone faces a health crisis or nears the end of life. But it is also significantly more expensive than starting out in traditional Medicare. This is because supplemental medigap plans charge much higher rates for those who have pre-existing conditions, or refuse them coverage outright.
My dad is heading into his second year in traditional Medicare, and several others I know are poised to follow. I only wish Congress were as easy to persuade that the free gym membership just isn’t worth it.
The post Friends don’t let friends sign up for Medicare Advantage. Here’s why. appeared first on MS NOW.
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