The second major issue is prior authorization. If you need a drug or procedure, your Medicare Advantage plan is going to make you go through several processes to get approved.”


— Brandy Bauer, director of State Health Insurance Assistance Program


plan you choose, everyone has to pay the Part B premium, which is currently $185 a month for most people and expected to increase by about $20 in 2026. At first glance, MA seems to be a


no-brainer. Besides the Part B premium, there


usually is no other upfront cost. And, unlike traditional Medicare, plans typically offer some dental, vision, and hearing coverage as well as a prescription drug plan and other benefits, such as gym membership and some over-the-counter products. MA also has an out-of-pocket


expense ceiling of about $9,500 annually for medical care and $2,000 for prescription drugs. In contrast, people who choose


original Medicare usually supplement their coverage with a Medigap policy, which is administered by private companies and costs an average of about $150 a month. This premium primarily covers


the 20% gap in Plan B coverage for doctors, diagnostic procedures,


and other medical care. Despite the low cost and added


benefits of MA, there are some drawbacks to these plans. “Usually, you have a restrictive


provider network, so you may have to change primary care providers or specialists,” Bauer tells Newsmax. “The second major issue is prior authorization. If you need a drug or procedure, your Medicare Advantage plan is going to make you go through several processes to get approved.” With original Medicare, you can


see any doctor who accepts Medicare anywhere in the country, and you don’t need referrals to see a specialist or get authorizations for procedures. “If you travel a lot or are a


snowbird, like someone who may live in Florida for part of the year and Maine the rest of the time, Medicare Advantage is probably not going to be the best choice because you want the ability to see any provider in the country,” explains Bauer. Another thing to consider when making your initial decision is that


Medigap insurers have fixed rates if you initially sign up with Medicare, but after that, premiums can balloon due to prior conditions and other factors, or you could even be denied coverage. So, if you start with an MA policy,


it will likely cost you considerably more — once again, for the rest of your life — if you want to switch to Medicare with Medigap coverage than if you’d done that at the outset. If, however, you choose an MA


plan and find that you don’t like it, you can easily switch to a different MA plan during the annual open enrollment period. Even after making your


Medicare/MA choice, you still have a lot of decisions. There are 10 different Medigap plans available, with different carriers offering different rates on different level policies, mostly based on deductibles and copayments. If you choose original Medicare,


there are also a variety of Part D options for drug coverage. MA likewise offers a plethora of


plans. The CMS rates them on a scale of one to five stars, but Meyers says the satisfaction levels are pretty good for most of them, as well as traditional Medicare. People who choose MA should not


only consider the insurer’s rating but also make sure their doctors are in the network and their medications are included in the drug plan. “Don’t trust their websites because


they sometimes have inaccurate information,” suggests Meyers. “Instead, call your doctors’ offices


to make sure they accept a specific MA plan, but keep in mind that contracts between the insurer and doctor can change over time.”


NOVEMBER 2025 | NEWSMAX MAXLIFE 97


COUPLE/RIDOFRANZ©ISTOCK / MONEY/DOUGLAS RISSING©ISTOCK


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