3 Reasons Retirees Shouldn’t Enroll in Medicare Advantage for 2025

At this point, we’re only a few weeks away from Medicare’s fall open enrollment period. If you haven’t yet purchased your insurance for 2025, now is the time to take action.

You can switch from your current Medicare Advantage plan to a new one during open enrollment. Or you can drop Medicare Advantage and switch to original Medicare.

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You may be tempted to stick to Medicare Advantage in one shape or form, and there can be benefits to doing so. The good thing about the program is that it limits your out-of-pocket expenses. This is a huge number when you are retired and have a fixed income.

Here’s how you can buy protection with Original Medicare: Medigap plan. However, you may prefer to know that your healthcare expenses during the year cannot exceed a certain threshold.

Medicare Advantage it also often offers additional benefits on top of what original Medicare would pay. The Kaiser Family Foundation (KFF) reports that by 2024, 99% of Medicare Advantage plans will offer vision benefits, while 98% will offer dental care.

Despite these benefits, you may want to look outside of Medicare Advantage for your 2025 coverage. Here are a few reasons why.

1. You may lose access to your trusted providers

Medicare Advantage may seem like a great type of health insurance for seniors, but many providers and hospital networks are cutting ties with Medicare Advantage. Reasons for this include high rates of patient claim denials, burdensome prior authorization requirements and delays in reimbursements.

If you have a core team of providers you trust to manage your care, you may not be able to maintain access to them as a Medicare Advantage member. switch to original Medicare It can give you access to more doctors and hospitals in your area.

2. You may have to pay for benefits you don’t need or use

KFF reports that in 2024, 75% of Medicare Advantage plan enrollees with prescription drug coverage pay no premiums other than the Part B cost. But some Medicare Advantage plans come with sizable premiums that may not be worth the cost. If you’re paying too much, it’s time to reevaluate.

You may be paying for a Medicare Advantage plan that offers many extra benefits, from meal delivery to house cleaning. But if you’re not using these benefits or you’re ineligible to use them because you don’t qualify for a health-related reason, you could be throwing away your money.

In this case, you can try switching to a $0 premium Medicare Advantage plan. But when you factor in expenses outside of plan premiums, you may find that your total costs are still higher.

3. You may have trouble splitting your time between states

It’s not uncommon to embrace the snowbird lifestyle in retirement or split your time between different parts of the country for reasons unrelated to the weather. The problem with Medicare Advantage is that it limits you to a specific provider network. If you spend a lot of time out of state, you may find it difficult or costly to obtain coverage.

Don’t assume access to telehealth will solve the problem. In some cases, there may be rules prohibiting providers from providing care to out-of-state patients; but in theory, it shouldn’t matter if you’re logging in to a wellness visit from South Carolina, Ohio, or anywhere else. in Arizona.

There are definite advantages to enrolling in Medicare Advantage. But before you decide to sign up for a Medicare Advantage plan in 2025, consider the pitfalls you may face and find out whether original Medicare makes more sense for you.

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