The 6 Biggest Medicare Advantage Disadvantages Every Enrollee Should Know About in 2027

Medicare Advantage can bundle medical, drug, dental, vision, and other coverage into one plan, often at a low additional premium. But heading into 2027, rising medical costs are putting pressure on insurers even as federal payments grow more slowly. If Medicare is part of your retirement plan, that gap could show up in ways that affect both your wallet and your care.

The Centers for Medicare & Medicaid Services (CMS) finalized an average 2.48% increase in Medicare Advantage payments for 2027, excluding its estimate for risk-score trends. Meanwhile, Humana told investors that it planned to adjust benefits where necessary for 2027 due to rising costs.

Here are six drawbacks that Medicare Advantage beneficiaries should watch closely.

Prior authorization can still delay needed care

Medicare Advantage plans can require prior authorization before they'll pay for certain services, unlike Original Medicare in most cases. A 2026 HHS Office of Inspector General report found that 19 Medicare Advantage organizations denied 12% of skilled nursing facility admission requests reviewed from June 2024. When beneficiaries or providers appealed those denials, plans overturned 95% of them.

That doesn't mean every denial is improper, and insurers are taking steps to reduce some authorization requirements. Still, an appeal takes time — and for someone recovering from surgery or a hospitalization, that delay can matter.

Provider networks can limit where you get care

Original Medicare generally lets you visit any participating provider nationwide, while many Medicare Advantage plans rely on networks. Medicare.gov says HMO members generally must use in-network doctors and hospitals except for emergencies, urgent care, and certain dialysis services.

That becomes especially important if a longtime specialist or preferred hospital leaves your network. Rural beneficiaries can face an additional challenge: KFF found that people in the most rural areas had access to about 20 Medicare Advantage plans on average in 2026, compared with 42 in urban areas.

Low premiums and extra benefits can shrink

The $0-premium pitch has helped make Medicare Advantage attractive, but plans reset their premiums, copays, and supplemental benefits every year. Some plans can reduce part of your Part B premium, but that benefit isn't available everywhere.

Benefits such as dental, vision, and over-the-counter allowances may also change from one year to the next. Humana has already said it sees a persistent gap between Medicare Advantage funding and medical cost trends and expects to make benefit adjustments as needed for 2027. That means a plan that worked well in 2026 may become more expensive or less generous in January.

Your prescription coverage can change

Most Medicare Advantage plans include Part D drug coverage, but formularies, pharmacy networks, and coverage rules can change annually. Medicare explains that drug plans can use prior authorization, step therapy, and quantity limits, all of which can affect how easily you fill a prescription.

A medication can also move to a different cost-sharing tier or face different restrictions in the new plan year. That's why checking only whether your premium changed isn't enough — you should rerun every regular prescription through Medicare's Plan Compare tool before renewing.

Your plan could disappear altogether

Sometimes the change is more dramatic: An insurer can stop offering a specific Medicare Advantage plan or leave a county entirely. If a Medicare Advantage contract isn't renewed, Medicare provides a Special Enrollment Period, and beneficiaries who don't choose another Medicare Advantage plan are generally moved to Original Medicare when their current coverage ends.

That can be particularly disruptive if you're midway through cancer treatment, rehabilitation, or another complex course of care. Medicare does provide some transition protections for ongoing prior-authorized treatment, but a new plan may still mean different doctors, pharmacies, copays, or coverage rules. People in counties with fewer competing plans have less room to shop around.

Switching back to Original Medicare can get complicated

This drawback often gets overlooked. You can leave Medicare Advantage and return to Original Medicare during an eligible enrollment period, but that doesn't necessarily mean you can easily buy a Medigap policy to cover Original Medicare's deductibles and coinsurance. Outside your six-month Medigap open enrollment period or another guaranteed-issue situation, insurers may charge more or deny coverage based on medical underwriting.

There is an important exception, however. If your Medicare Advantage plan leaves Medicare or stops serving your area, you may have a federal guaranteed-issue right to buy certain Medigap policies when you switch to Original Medicare. Someone voluntarily leaving an otherwise continuing plan may not have that same protection.

Bottom line

Would your current Medicare Advantage plan still work if your doctor left the network, your prescription moved to a higher tier, or a dental benefit disappeared? Your Annual Notice of Change, which arrives each fall, spells out changes taking effect in January. Medicare Open Enrollment runs from Oct. 15 through Dec. 7, with new coverage beginning Jan. 1.

Before that window closes, check your specific doctors, hospitals, prescriptions, premium, maximum out-of-pocket limit, and supplemental benefits rather than assuming this year's coverage carries forward unchanged. Doing that annual review can help you lower your financial stress and reduce the odds of discovering an expensive coverage change after you need care.

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