Medicare beneficiaries have a wide selection of Medicare Advantage plans to choose from, but the quality and coverage can vary significantly. In 2026, 97% of beneficiaries will have 10 or more Medicare Advantage plans to choose from, according to the Centers for Medicare & Medicaid Services (CMS). This means identifying truly high-quality options requires more than just glancing at appealing marketing materials.
Plans often highlight their most attractive benefits upfront, while potential drawbacks are tucked away in the fine print. It’s important to examine the specifics of each plan and assess covered benefits, expenses, network limitations, and supplementary benefits prior to deciding. This process may seem overwhelming, so it may be worth considering working with an independent Medicare agent or consultant to help decipher the information.
For free, unbiased guidance, you can reach out to your State Health Insurance Assistance Program, which can help you review and compare your options.
[READ: Medicare Advantage Initial Enrollment Period and Special Enrollment Periods]
—
### What Are Medicare Advantage Plans?
Individuals eligible for Medicare have the option to receive their benefits through original Medicare, which consists of Part A and Part B, or they can opt for a Medicare Advantage plan, known as Part C. Run by private insurance companies, Medicare Advantage plans are required to provide the same coverage as original Medicare but often offer additional benefits that original Medicare does not include.
“A big advantage to these plans is that they can be a one-stop shop, which is appealing to many people. For many plans, you do not need to shop for a separate prescription drug plan, and in many cases, some dental, vision, and hearing are also covered,” says Shannon Benton, executive director of The Senior Citizens League in Alexandria, Virginia.
[READ: Medicare vs. Medicare Advantage: How to Choose.]
—
### Drawbacks to Medicare Advantage Plans
While Medicare Advantage plans have many positives, they also have drawbacks that need to be taken into consideration when deciding if a plan is the right match for your health care needs.
#### Additional Benefits
A large portion of Medicare Advantage plans come with benefits that original Medicare does not offer, such as dental, vision, or hearing coverage. Others may include gym memberships, home health services, and other perks. While these extra benefits can sound tempting, make sure you understand what is and is not covered.
What many people don’t realize is that these benefits are often limited and geared more toward preventive rather than comprehensive care. Also, depending on the plan and service, you may need prior authorization to use them.
#### Out-of-Pocket Maximums
Unlike original Medicare, Medicare Advantage plans are required to have out-of-pocket maximums, but the actual amount varies by plan up to the amount set by Medicare.
| Medicare Advantage Network Services 2026 | Out-of-Pocket Maximum |
|—————————————–|———————-|
| In-network services | $9,250 |
| Combined in-network and out-of-network services | $13,900 |
While Medigap plans can help cover many out-of-pocket costs under original Medicare, no equivalent supplemental plans exist for Medicare Advantage. That means you’re responsible for the full amount of your plan’s out-of-pocket expenses.
#### Drug Coverage
A majority of plans come with prescription drug benefits, which is a big draw for many. Before committing to a plan, check their formulary to confirm that your medications are included and what your associated costs will be.
“Many beneficiaries mistakenly believe their Medicare Advantage plan’s maximum out-of-pocket limit includes prescription drug costs, but those expenses are separate,” says Kelli Jo Greiner, a health care policy analyst and Medicare product manager with the Minnesota Board on Aging in St. Paul, Minnesota.
It’s important to note that prescription drug costs are capped at $2,100 for 2026. The exact amount of your deductible depends on the plan, but no Medicare drug plan can have a deductible higher than $615 in 2026. If you take a lot of medications, be sure to confirm your out-of-pocket costs per drug so you aren’t surprised later on.
#### Geographic Limitations
Most Medicare Advantage plans have limited coverage outside their geographic region, which can be problematic if you travel frequently or spend time in multiple locations throughout the year. You cannot go to any doctor, lab, or hospital in the U.S. that participates in Medicare as you can if you are covered under original Medicare.
Also, if your provider happens to be a few towns over but outside the area covered by your Medicare Advantage plan, you will need to find a new provider to utilize your in-network benefits. However, there are exceptions, such as needing urgent or emergency care.
#### Network Restrictions
Medicare Advantage plans typically operate within specific networks of health care providers. If you have a preferred doctor or specialist who is not in the plan’s network, you may face higher out-of-pocket costs or you may not be able to see them at all, except in emergencies or with prior authorization.
“Your lack of choice with providers is one of the biggest pitfalls, and it’s especially bad in rural areas where there aren’t always a lot of doctors to pick from anyway,” Benton says.
#### Premiums
When a company advertises their plans come with a $0 premium, it sounds too good to be true, and it often is. What you need to be aware of is that this typically means no additional premiums.
The federal government pays Medicare Advantage insurance companies a fixed amount per enrollee to provide health care services. Like those who enroll in original Medicare, Medicare Advantage enrollees need to help pay their part.
“Medicare Advantage plans must cover everything original Medicare covers, so enrollment in Parts A and B is required,” Greiner says. The monthly 2026 Part B premium is projected to be $206.50. Some plans, however, offer a Part B giveback, which can help offset that cost.
According to the CMS, Medicare Advantage plans that charge an additional premium beyond the standard Part B amount are expected to see an average monthly cost decrease from $16.40 in 2025 to $14 in 2026.
#### Plan Changes
Medicare Advantage plans can change from year to year, so your premiums, deductibles, cost-sharing, drug coverage, or network of doctors and pharmacies may be different in 2026.
Aetna (CVS Health), Humana, and United Health Group have already announced their plans to scale back their Medicare Advantage offerings in 2026. This move comes in response to financial pressures such as changes in government funding and increasing health care costs, leading insurers to reduce coverage in less profitable regions.
To see how you may be affected, review your Annual Notice of Change (ANOC), which your plan is required to send by September 30. The ANOC outlines updates to coverage, costs, and other modifications.
Unlike original Medicare, Medicare Advantage plans can also change mid-year. If your provider leaves the network or your medication is removed from the formulary, you may need to select a new plan to ensure your health care needs continue to be covered.
#### Prior Authorizations
It’s common for Medicare Advantage plans to require prior authorizations. While this practice helps to control health care costs, it can prevent or delay medically necessary care.
In 2022, a study found that some plans were delaying or denying prior authorizations that met Medicare coverage rules. Since then, Medicare Advantage plans have made significant changes to reduce inappropriate prior authorization denials.
New federal rules require plans to follow original Medicare’s coverage criteria and ensure that denial decisions are reviewed by licensed clinicians. Plans must also meet stricter deadlines for processing requests and are required to publicly report denial rates and appeals.
#### Referrals
Many Medicare Advantage plans require a referral from your primary care physician to see a specialist. Depending on the plan and how long the referral approvals process (and if necessary, appeals process) takes, this could delay necessary care.
[READ: Medicare Advantage HMOs vs. PPOs: Which Is Right for You?]
—
### Traits of Worst Medicare Advantage Plans to Look For
To figure out if a specific Medicare Advantage plan is not a good one, watch for these warning signs:
– **Frequent plan changes** from year to year. If benefits, costs, drug coverage, or networks change drastically from one year to the next, it could indicate a problem with either the plan or insurance company.
– **High out-of-pocket costs.** A $0 premium may be tempting as it could save you money upfront, but often these plans also come with higher out-of-pocket costs when you use care. A bad plan may have high copays, coinsurance, or deductibles, especially for hospital stays, outpatient surgery, or specialist visits.
– **Limited extra benefits or gimmicky perks.** A plan that heavily advertises fringe perks (like gym memberships or gift cards) but offers weak medical coverage may not be worth it.
– **Limited provider network.** If your preferred doctors, specialists, or hospitals are not in-network, or if the plan frequently changes its network, you could face higher costs or need to change providers.
– **Low star ratings.** Medicare rates plans from 1 to 5 stars. Plans that are under 3 stars for several years in a row may have poor customer service, limited benefits, or management issues. Go to Medicare’s plan finder, input your ZIP code, and you will find the range of plans available to you along with their star ratings. You can also use U.S. News’ Best Medicare Advantage Companies search tool to find plans near you.
– **Poor coverage for your specific needs.** The plan may lack adequate coverage for medications, durable medical equipment, or chronic condition management, which is critical if you have ongoing health needs.
– **Poor customer service.** If you see consistent complaints or reviews mentioning billing errors, difficulty reaching support, or delayed claims, consider it a red flag.
– **Restrictions on referrals and authorizations.** Plans that require frequent prior authorizations or referrals for specialists can delay or limit your access to care.
—
### How to Pick a Medicare Advantage Plan
Like shopping for any insurance, deciphering the advantages and disadvantages of Medicare Advantage plans can be difficult. Nobody has a crystal ball that can tell them what their future needs will be, but having a conversation with your providers about what they potentially see coming up may be the next best thing.
Some questions to ask yourself include:
– Is having certain extra benefits in a plan important to me?
– Are my providers within the geographic area that the plan encompasses? If not, can I comfortably switch providers?
– What is my game plan if I split my time between two locations during the year?
– What are my thoughts about the restrictions a limited provider network, referrals, and prior authorizations may place on me?
– Which pharmacies are in-network, and are they a reasonable distance away?
– Am I OK with the hassle and potential extra costs I would be responsible for if I go out-of-network?
– Is bundled prescription drug coverage in a plan important to me?
—
### Bottom Line
With so many Medicare Advantage plans available, it can be hard to figure out which one to choose and which ones to stay away from. Ultimately, the best Medicare Advantage plan is what works best for you and your health care needs. What are your must-have benefits and your wants? Being diligent in your research and upfront with your needs can go a long way to finding the plan that’s right for you.
—
### Additional Resources
– [When and How to Change Your Medicare Plan](#)
– [How to Avoid Paying a Medicare Late Enrollment Penalty](#)
– [How to Avoid Medicare Fraud](#)
—
*Worst Medicare Advantage Plans: How to Find a Good One* originally appeared on usnews.com
*Update 10/17/25: This story was previously published at an earlier date and has been updated with new information.*
https://wtop.com/news/2025/10/worst-medicare-advantage-plans-how-to-find-a-good-one/
