Key Points
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Medicare Advantage plans give you a single policy to worry about.
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These plans also cap your annual out-of-pocket spending, unlike Original Medicare.
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You may need to stick to a specific provider network and get referrals for specialists with Medicare Advantage plans.
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The annual Medicare Open Enrollment Period is now underway and will run through Dec. 7. For many seniors, this is your only opportunity to select new health insurance coverage for 2027, so it’s definitely worth setting aside time to review your existing plan and competing options.
One of the biggest decisions you’ll have to make is whether to stay on Original Medicare or switch to a Medicare Advantage plan. Here are two pros and two cons of switching to a Medicare Advantage plan to help you decide whether it’s right for you.
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Two reasons to switch to a Medicare Advantage plan
Here are the main advantages of switching to a Medicare Advantage plan in 2027:
1. You want a single policy to deal with
Original Medicare has many gaps, and some people choose to fill them with Medicare supplement policies. But then you’re juggling multiple plans, each with its own premiums, deductibles, and co-pays.
Medicare Advantage plans simplify that. You have a single policy through a private insurer that covers everything Original Medicare does, plus some extras, and you only have one set of retirement healthcare costs to worry about.
2. You want an annual out-of-pocket maximum
Medicare Advantage plans have an annual out-of-pocket maximum that limits how much of your own money you have to spend on healthcare costs. This could be a big advantage, particularly if you’re in poor health and expect to spend a lot on doctor visits next year.
Be sure to review your plan’s out-of-pocket maximum and compare it with those of other Medicare Advantage plans to ensure it fits within your budget.
Two reasons not to switch to a Medicare Advantage plan
Here are some drawbacks worth weighing before you switch to a Medicare Advantage plan:
1. You’ll have a more limited provider network
If you stick with Original Medicare, you can visit any provider in the country that accepts Medicare. Medicare Advantage plans, however, usually require you to stick to their provider network for nonemergency care. Some plans will cover out-of-network treatments, but they may cost you more.
If you’re considering switching to a Medicare Advantage plan, make sure it covers all the doctors and hospitals you currently use. Contact the plan administrator if you’re not sure about this.
2. You may need a referral to see a specialist
Original Medicare doesn’t require you to get a referral from your primary care physician to see a specialist, but Medicare Advantage plans usually do. This could mean extra trips to the doctor’s office and more time waiting to see the provider you need.
When reviewing Medicare Advantage plans, check their policies regarding specialist visits. You can always contact the provider directly if you’re not sure.
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