Key Takeaways

• Medicare Advantage plans in 2025 continue to attract enrollees with extra features like dental, vision, hearing, and wellness benefits. But the convenience may come with trade-offs you shouldn’t ignore.

• While these plans often bundle multiple types of care into one, they may limit your choice of providers and require stricter approval for certain services.

Why So Many Choose Medicare Advantage Plans

More than half of all Medicare beneficiaries are now enrolled in Medicare Advantage plans. That number continues to rise in 2025, and there are a few clear reasons for that. These plans, also known as Medicare Part C, offer an all-in-one alternative to Original Medicare. Instead of enrolling in separate plans for hospital coverage, medical coverage, and drug coverage, you can often get everything bundled under a single plan.

Many people find this structure appealing because:

• It offers simplicity with fewer separate bills or ID cards.

• You can get additional benefits beyond what Original Medicare provides.

• Monthly premiums are often lower than the combined cost of Original Medicare plus a standalone drug plan and supplemental coverage.

But the ease of enrollment and attractive extras can sometimes hide downsides you may not fully see until you start using the plan.

The Extra Perks That Get the Most Attention

In 2025, Medicare Advantage plans commonly include services that Original Medicare doesn’t cover at all. These extras continue to be among the top reasons people enroll:

Dental, Vision, and Hearing Coverage

Many Medicare Advantage plans include:

• Preventive and routine dental exams

• Cleanings, x-rays, and sometimes restorative care

• Eye exams, eyeglasses, or contact lenses

• Hearing tests and hearing aids

These benefits are particularly attractive because traditional Medicare does not cover them unless connected to a medical condition.

Wellness and Fitness Benefits

Medicare Advantage plans often provide wellness programs such as:

• Gym memberships

• Home fitness kits

• Weight loss programs

• Nutrition coaching

They can help you maintain a healthy lifestyle and reduce your long-term medical needs.

Over-the-Counter Allowances

Plans may include a monthly or quarterly allowance that you can use to purchase non-prescription items like pain relievers, vitamins, or first aid supplies.

Transportation and Meal Support

Some plans help cover transportation to medical appointments and may even offer meals delivered after hospital discharges. These services aim to support recovery and reduce readmission rates.

These additional services are a big part of the appeal. But understanding what you may be giving up is just as important.

The Network Restrictions You Might Overlook

Unlike Original Medicare, which allows you to visit almost any doctor or hospital that accepts Medicare, Medicare Advantage plans usually have more restrictive provider networks.

Provider Networks Vary

• HMO (Health Maintenance Organization) Plans: Require you to use in-network providers except in emergencies. You typically need a referral to see a specialist.

• PPO (Preferred Provider Organization) Plans: Offer more flexibility, but still charge more if you go out-of-network.

If your current doctor is not in your plan’s network, you may need to switch providers or pay more out of pocket.

Prior Authorization Requirements

Many services require approval before they will be covered. This includes imaging, hospital stays, and specialty services. While this is designed to control costs and prevent unnecessary care, it can delay treatment.

In 2025, there is increased attention on improving transparency in these processes, but delays and denials remain a concern.

Coverage Differences That Catch People by Surprise

You might assume all Medicare Advantage plans offer the same protections as Original Medicare, but that’s not always the case. You need to read the plan details closely.

Out-of-Pocket Maximums

Medicare Advantage plans must set a yearly limit on how much you pay for covered services. For 2025, the in-network maximum can be as high as $9,350, and $14,000 if you include out-of-network services.

These caps protect you from catastrophic expenses, but reaching them means you’ve already paid thousands in copays and coinsurance.

Emergency and Urgent Care

Emergency care is covered nationwide, even outside your plan’s network. But routine care while traveling may not be. If you spend extended time in another state or plan to move, your coverage might not follow you.

Prescription Drug Coverage

Most Medicare Advantage plans include Part D drug coverage. But formularies (lists of covered drugs) vary by plan. You might find that a drug covered in one plan is not covered in another or comes with higher copays.

Be sure to review:

• Tier levels for your medications

• Whether prior authorization is required

• Restrictions like quantity limits or step therapy

The Fine Print in Plan Changes

Every fall, plans update their benefits and costs for the upcoming year. These changes can affect everything from your drug coverage to your provider network.

If you’re enrolled in a plan in 2025, watch for your Annual Notice of Change (ANOC) letter each September. It will outline what’s different for the next year. This letter gives you time to decide whether to stay in your plan or switch during Open Enrollment (October 15 to December 7).

Failure to review this letter can lead to surprises in January—such as new copays, higher out-of-pocket costs, or discontinued benefits.

Coordination with Medicaid or Employer Coverage

Some Medicare Advantage enrollees also qualify for Medicaid or maintain employer or union coverage. In these cases, it’s important to understand how the two forms of coverage interact.

• Medicaid may cover premiums, copays, or out-of-network care.

• Employer coverage might require you to keep Original Medicare or coordinate benefits differently.

If you qualify for both Medicare and Medicaid, consider a Dual Eligible Special Needs Plan (D-SNP). These are tailored to coordinate both types of coverage, but you still need to verify your providers are in the plan’s network.

What Happens When You Want to Switch Plans

Switching from Medicare Advantage to Original Medicare or another plan can be more complicated than many realize.

• If you’ve been in a Medicare Advantage plan for more than a year and want to switch to Original Medicare and buy a Medigap policy, you may have to go through medical underwriting.

• Medigap insurers can deny coverage or charge higher premiums based on your health history if you don’t qualify for guaranteed issue rights.

There are limited windows for making changes:

• Open Enrollment (October 15 to December 7): You can change your Medicare Advantage plan or switch back to Original Medicare.

• Medicare Advantage Open Enrollment (January 1 to March 31): You can switch Medicare Advantage plans or return to Original Medicare, but not enroll in a Part D plan unless you’re going back to Original Medicare.

Missing these periods may lock you into a plan until the following year.

Annual Cost Reviews Are Essential

Even if your current Medicare Advantage plan worked well in the past, it may not be the best fit now. Premiums, deductibles, and coinsurance can all change from year to year. Also, your health needs evolve.

Each fall, you should:

• Review your Annual Notice of Change

• Compare plans in your area

• Check your medications against new formularies

• Confirm your doctors and hospitals are still in-network

These steps can help ensure your plan continues to meet your needs without unexpected costs.

What to Weigh Before Enrolling in a Plan

Before choosing a Medicare Advantage plan, take time to consider your priorities. Are you mostly healthy and attracted to the extra benefits? Or do you need more predictable access to specialists and freedom to travel for care?

Ask yourself:

• How important is provider flexibility?

• Do you need frequent care or specialized services?

• Are your prescriptions on the plan’s formulary?

• How much can you realistically afford in copays and coinsurance?

Medicare Advantage may be the right fit for many, but that decision should come from fully understanding both the benefits and limitations.

Making the Most of Your Medicare Choice in 2025

Medicare Advantage plans continue to offer attractive extras and a bundled approach that many people appreciate. But before you enroll, take time to look closely at how those perks are balanced with network restrictions, prior authorization, and variability in costs.

What feels convenient now could come with future trade-offs. That’s why comparing plans based on your actual health needs and budget is more important than ever in 2025.

For help weighing your options, reach out to a licensed agent listed on this website. They can guide you through the details and help you make a choice that fits both your medical and financial priorities.