Medicare Advantage Plans 2025: Pros and Cons
Choosing a Medicare plan is one of the most important healthcare decisions that older adults and their caregivers face, but it's not always clear which option is best. With rising healthcare costs and ever-evolving health needs, finding the right coverage can affect both your wallet and your well-being. Having the right plan in place can seriously impact your mental health as well.
We’ll walk you through the pros and cons of Medicare Advantage plans, Medicare Advantage vs Original Medicare, and what family caregivers should know when helping a loved one make this important decision.
What is Medicare Advantage?
First of all, what is Medicare Advantage and why does it have such a fancy name? The program itself began in 2003, when the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) was passed into law. Its origins go back way farther, all the way to the 1970s, but for our purposes there's no reason to dive into the history.
The important thing to know is that Medicare Advantage evolved from decades of managed care programs under Medicare, each of which aimed to provide more patient care coordination and additional benefits through private insurers.
How Medicare Advantage Differs from Original Medicare
Original Medicare offers more flexibility in provider choice and doesn't bundle extra services or a drug plan by default. It's a government-run program and includes:
- Part A (Hospital Insurance)
- Part B (Medical Insurance)
Medicare Advantage, also known as Part C, is an all-in-one alternative offered by private insurance companies approved by Medicare. These plans must cover at least the same services as Original Medicare, but often include additional benefits. As such, they provide more coverage in one plan, but with less flexibility in choosing providers and may require more managed care like prior authorizations or referrals.
What’s Typically Included in Part C
Medicare Advantage is an alternative way to receive Medicare benefits, offered by private insurance companies that are approved by Medicare. With Advantage, Medicare pays the private insurer a fixed amount each month to provide your care. You still have to pay your Part B premium, and sometimes an additional premium for the Advantage plan itself.
Medicare Advantage plans bundle together:
- Part A (hospital insurance)
- Part B (medical insurance)
- Often Part D (prescription drug coverage)
Plus some additional benefits, such as:
- Vision
- Dental
- Hearing
- Wellness programs
- Sometimes transportation or over-the-counter allowances
Who Offers Medicare Advantage Plans
Part C plans are provided by private insurers like UnitedHealthcare, Humana, and Aetna. Availability and features vary by region, and each provider offers multiple plan options. Later in this blog, we offer a few resources for you to easily compare your options.
Pros of Medicare Advantage Plans
As you can surely already tell, Medicare Advantage offers some definite benefits over Original Medicare, which leads many to call it one of the best medicare plans for seniors.
1. The Convenience of All-in-One Coverage
Medicare Advantage combines your hospital, medical, and sometimes drug coverage into a single plan, simplifying the healthcare experience. This is especially helpful for caregivers managing care, so that they have one less plan and subsequent paperwork to sort through.
2. Extra Benefits (Vision, Dental, Fitness)
Unlike Original Medicare, most Advantage plans include perks such as:
- Dental cleanings
- Vision exams and glasses
- Hearing aids
- Gym memberships through programs like SilverSneakers
Having these additional perks included in Medicare Advantage can add to that simplification and convenience aspect, but it can also encourage healthier living, particularly for seniors who otherwise may not pursue dental coverage or a gym membership.
3. Potential Cost Savings on Premiums
Many Medicare Advantage plans have $0 premiums (though you still pay your Part B premium). Some plans also offer lower Medicare Advantage costs on copays and deductibles compared to Original Medicare with supplemental Medigap plans.
4. Annual Out-of-Pocket Limit
One major advantage of Part C is the maximum annual out-of-pocket limit, which caps your costs and offers financial protection—peace of mind not available under Original Medicare.
Cons of Medicare Advantage Plans
But insurance can't be that simple, right? As anyone who's painstakingly compared insurance plans knows, there are a lot of nuances within the American insurance system. Despite Medicare Advantage's benefits, there are certainly some downsides.
1. Limited Provider Networks
Medicare Advantage plans often use HMO or PPO networks, which may restrict access to doctors and hospitals. If you travel or have preferred specialists, check whether they’re in-network.
2. May Require Referrals for Specialists
Unlike Original Medicare, many Advantage plans require referrals to see specialists, adding an extra step for time-sensitive care.
3. Geographic Limitations for Coverage
Most plans are region-specific, which can complicate care if you split time between states or travel frequently. Planning ahead for appointments can help a lot, but it's also an added complication over Original Medicare.
4. Plan Complexity and Varying Rules
With hundreds of plan options, each with different benefits, costs, and rules, comparing plans can be overwhelming—especially for new retirees or caregivers supporting aging loved ones.
Key Considerations Before Choosing a Plan
Insurance is never as simple as you'd wish, but family caregiving and medicare decisions are all about listing out your must-haves and figuring out which option best suits you and your loved ones.
Your Current and Future Healthcare Needs
Think about what you need your insurance to do today but also months and years from now. Consider:
- Ongoing conditions
- Planned procedures
- Upcoming healthcare changes
Coverage Where You Live and Travel
If you travel seasonally or have multiple residences, ensure the plan covers you outside your home region. If you regularly travel to loved ones in a different state, prioritize making sure that your chosen Medicare plan covers that state as well as your home state.
Access to Preferred Doctors and Hospitals
Always check the plan’s provider directory to make sure your healthcare providers are in-network. No one wants to change doctors due to insurance, and your healthcare provider's office should be able to answer all your coverage questions.
Prescription Drug Needs
Look into each plan’s formulary (drug list) to ensure your medications are covered affordably.
How Family Caregivers Can Help with Medicare Choices
Digging into the complexities of insurance plans is no one's favorite pastime, but it can be a lot more arduous for elderly loved ones. This is an area where AI tools like ChatGPT or Gemini are pretty excellent for simplifying a complicated list of options, and you could benefit from throwing a few clarifying questions into an AI chat tool in order to fact check your understanding before you commit. As always, make sure you're doing your own research with blogs like this one.
Evaluating Options Together
Work with your loved one to list out healthcare priorities, preferred providers, and budget. Use comparison tools to evaluate the best Medicare plans for their situation. It may even be beneficial to check out some forums like Reddit, Facebook Groups, or talk with friends and family who have been in similar situations.
Using Comparison Resources
You can visit Medicare.gov to:
- Compare plans side by side
- Read star ratings
- Check provider and drug coverage
Another great resource is AARP Medicare Plans for trusted options tailored for seniors.
Staying Organized with Tools Like Caily
We know that managing healthcare can be overwhelming, which is why we created the all-in-one caregiving app. Among many other useful functions, Caily’s platform lets families track:
- Shared calendar events, like enrollment deadlines
- Appointment notes and documents
We've built our app to help organize every aspect of caregiving, from vitals and daily check-ins to shared chat and medication reminders. By collecting everything in one place, we reduce stress and ensure that no detail is missed.
Is Medicare Advantage Right for You?
Medicare Advantage plans offer valuable benefits, convenience, and potential savings. But they come with trade-offs like limited networks and geographic restrictions. Every individual and caregiving situation is unique, and unfortunately there’s no one-size-fits-all answer with insurance coverage.
Before choosing a Medicare plan, evaluate all the options with your care team. Consider how well a plan meets your needs today, and in the future.
Choosing Medicare coverage is a big decision. Use Caily to track questions, appointments, and documents — and feel confident every step of the way. Sign up for our waitlist to get notified when we go live in Summer 2025!
For more help, check out our blog on Managing Healthcare Costs When Caring for a Loved One.
FAQs About Medicare Advantage Plans
What is Medicare Advantage?
Medicare Advantage (Part C) is a type of Medicare health plan offered by private insurance companies approved by Medicare. These plans provide all the benefits of Original Medicare (Part A and Part B) and often include extra coverage like:
- Prescription drugs (Part D)
- Vision, dental, and hearing coverage
- Fitness memberships
- Telehealth and wellness programs
Unlike Original Medicare, Medicare Advantage plans have an annual out-of-pocket maximum, which can help limit your costs. However, most plans require you to use a network of doctors, may be restricted to certain regions, and may need prior authorization for certain services.
Why Are Medicare Advantage Plans Considered Bad by Some?
While many people benefit from Medicare Advantage, some critics highlight these potential downsides of Medicare Advantage plans:
- Limited provider networks: You may be required to see in-network doctors or get referrals.
- Prior authorizations: Some plans require approval before covering certain services, which can delay care.
- Coverage denial rates: Studies have shown some plans may deny medically necessary services more often than Original Medicare.
- Confusing plan options: With so many plans available, it can be hard to compare costs and coverage.
That said, not all Medicare Advantage plans are bad! The key is to compare plans carefully based on your location, providers, prescriptions, and health needs both today and in the future.
How to Get a Medicare Advantage Plan?
Getting a Medicare Advantage plan is a straightforward process:
- Enroll in Medicare Parts A and B. You must have both to be eligible.
- Use the Medicare Plan Finder to compare plans in your area, or use an insurance broker.
- Check your preferred doctors and prescriptions to ensure they're covered.
- Enroll during a valid enrollment period, such as:
- Initial Enrollment Period (around your 65th birthday)
- Annual Enrollment Period (Oct 15 – Dec 7)
- Medicare Advantage Open Enrollment (Jan 1 – Mar 31)
- Submit your application online, over the phone, or through an agent.
Many plans have $0 premiums, but be sure to review copays, deductibles, and network limits.
What Is the Best Medicare Advantage Plan?
The best Medicare Advantage plan depends on your individual needs, and there’s no one-size-fits-all answer. However, some of the top-rated Medicare Advantage providers in 2025 (according to CMS Star Ratings) include:
- Humana
- UnitedHealthcare (AARP)
- Aetna
- Blue Cross Blue Shield
- Kaiser Permanente
When choosing the best plan for you, consider:
- Provider network: Are your preferred doctors in-network?
- Prescription drug coverage: Are your medications covered affordably?
- Out-of-pocket costs: What’s the max you’ll pay in a year?
- Extra benefits: Do you need dental, vision, or hearing coverage?