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PULLING BACK THE CURTAIN ON MEDICARE ADVANTAGE PLANS
- Michael Braden
- Mar 5
- 7 min read
Michael T. Braden March 7, 2026 MEDICARE ADVANTAGE
Picture of Braden Medicare Insurances' Pulling Back The Curtain On Medicare Advantage Plans Poster
PULLING BACK THE CURTAIN ON MEDICARE ADVANTAGE PLANS
Welcome to the Braden Medicare Insurance Blog. I think today's article will be interesting and informative for anyone approaching their Medicare eligibility window (IEP), as well as for anyone who is currently a Medicare Beneficiary.
I began my career as an Independent Medicare Broker over 10 years ago. I am stating this to illustrate that we help anyone who needs help with Medicare. I am absolutely committed to being a great listener, an understanding teacher, and a bulldog when it comes to defending my clients and doing whatever I can to keep them safe and financially whole throughout their retirement years. I take pride in helping and serving others.
Some people are attracted to Original Medicare, while others like the flexibility of Original Medicare. Still, they want the security of adding a Medigap (Medicare Supplement) policy to strengthen their Original Medicare plan. Then some people are attracted to Medicare Advantage Plans (Medicare Part C or All-In-One plans).
I have many clients who have Special Health Needs, and some have Chronic Health Issues. I highly recommend SPN and C-SPNP for anyone with specific needs and health challenges.
Therefore, in the spirit of full disclosure, out of all of my clients, here is what my clients have chosen for their Medicare coverage:
2% Have Original Medicare by itself.
6% Medicare Advantage Special Needs (SPN) or Chronic Special Needs Plans (C-SNP),
14% Have Medicare Advantage Plans.
78% Have Original Medicare With A Medicare Supplement/Medigap policy.
And out of this group, 19% Have Plan F, 2% Have Plan C, 55% have Plan G, 22% have Plan N, and 2% Have High Deductible Plan G (HDG).
BEAUTY IS IN THE EYE OF THE BEHOLDER
Finding the BEST Medicare plan is not nearly as important as finding the BEST option for you, as an individual, and for your family.
I hope everyone who reads this article will commit to investing a little time in researching and learning about Medicare so you can make the best, well-informed plan choice for you. Please resist the outside noise, like your brother-in-law saying he has this guy at work who is on Medicare and loves his plan, or the woman who cuts your neighbor's hair saying her Sister in Missouri swears by her plan.
I will attest to anyone who asks me for my opinion that Original Medicare, coupled with a Medicare Supplement/Medigap Plan G, is the absolute best option, as it offers the most comprehensive coverage and is the top No-Brainer Medicare combination available. However, for myriad reasons, Original Medicare, with or without a Medicare Supplement policy, is not the best choice for many people.
And, there are just as many fans and advocates of Medicare Advantage plans. That is great, I am a fan and will support any Medicare Advantage plan that is the best option for a particular Medicare Beneficiary.
DON'T BE PENNY WISE AND POUND FOOLISH
Many times, when people are new to Medicare, they are typically in good health, so they often think they can get by on the cheap and get a Medicare Advantage Plan, thinking they can save money for a few years. Maybe a novel concept, but I have honestly witnessed bad things happen that left people unable to get a Medicare Supplement policy in the future because of something they did not expect. Insurance is what we pay to have someone else take on the risk. In the case of Medicare and a Medicare Supplement, this is to pay the 20% of Medicare costs that Medicare does not cover.
SOME OLD QUOTES & SAYINGS STILL RING TRUE TODAY
Everyone has one chance to enroll in any Medicare plan they desire during their IEP (Initial Enrollment Period) for Medicare. So if you are looking forward and trying to imagine what you want your Health Care and your Healthcare coverage to look like in your 80s and 90s, there is no good reason not to get a Medicare Supplement/Medigap plan of your choice when you first enroll in Medicare.
Once you have a Medigap/Medicare Supplement policy, it can never be taken away from you. You can rest easy knowing you will have consistent, predictable costs, and that after your modest Part B deductible each year ($283 in 2026), all of your Medical Bills will be 100% covered. You can see any doctor and go to any Hospital you choose, anywhere in the US. You pick your own doctor, and there are no networks to deal with.
The average Medicare Supplement Plan G premium for someone turning 65 in Arizona is $152 per month, or $1,824 per year. So if the average MOOP for a Medicare Advantage Plan is $6,000 or more, you can see the value in Medigap plans from a mile away.
THE TOP REASONS PEOPLE SAY THEY CHOSE A MEDICARE ADVANTAGE PLAN IN 2024
COMPREHENSIVE COVERAGE IN ONE PACKAGE
PREDICTABLE COSTS HELP YOU MANAGE BETTER
MORE BENEFITS BEYOND BASIC MEDICARE
COORDINATED CARE FOR A SEAMLESS EXPERIENCE
PRESCRIPTION DRUG COVERAGE IS INCLUDED
EXTRA PERKS WITH MOST PLANS
FLEXIBLE PLAN OPTIONS
POTENTIAL HEALTH SAVINGS DEPENDING ON YOUR NEEDS
WHY MOST MEDICARE ADVANTAGE PLANS ARE NOT ALWAYS ALL THEY'RE CRACKED UP TO BE
I am going to share some things with you that you may not know, might not understand, or perhaps have never heard of before. The purpose of sharing this information is to be transparent, in hopes that you are better informed about the inner workings of Medicare Advantage plans.
Did you know that.........................
You are not in control of Healthcare. You are a slave to your plan. They say what doctors are covered. Which hospital and SNF can you go to? How many Physical Therapy appointments can you, etc? You worked your entire life, so why are you willing to give up being in control of your own healthcare now?
Most "Extra" Benefits are based on Quarterly Benefit Amounts? So the $1000 in Dental Benefits you thought you had is usually just $250 per Quarter. You have to use only dentists in your plan's provider directory. Plus, major work like Implants, Crowns, and root canals is typically not covered. To know exactly what is covered, you should constantly read and refer to your plan's Evidence of Coverage.
You typically have a co-pay for everything with every Medicare Advantage HMO (Health Maintenance Organization) plan. An MRI will cost you $250-$400, and a Hospital Bed will cost $350-$450 per night for up to 7 nights.
Every MAPD (Medicare Advantage Plan With Prescription Drugs) has a MOOP (Maximum Out-Of-Pocket) amount. The average for all MA and MAPD plans available nationwide in 2026 is just over $6,000.
You may not need a referral to see a Specialist with a PPO (Preferred Provider Organization).
Most MAPD Plans include a Health Club Membership. However, only about 20% of Medicare Advantage plan members use it regularly.
You do not need a Medicare Advantage plan to get excellent Prescription Drug Coverage.
The US Government (CMS/Medicare) pays $12,000 per year to every Medicare Advantage insurance company for each person enrolled in one of its plans! Now you know how they get the money to advertise and use all their Bait-and-Switch tactics.
You are responsible for paying a 20% Co-Insurance for any Cancer Treatments (Radiation and Chemo), and in case you have not heard, those average $12-15K for each round of treatments.
Your plan can deny coverage, require you to get Prior Authorization in advance for anything, require you to get 2nd, 3rd, or 4th opinions for anything, and there is nothing you can do about it.
Medicare Part B Giveback Plans are misleading. They increase the MOOP and only return a small portion of the benefits of your premium. You have most other plans with more overall benefits and lower MOOP costs. The insurance companies know this, and they take advantage of you.
In 2026, The Average MOOP for Medicare Advantage plans nationwide is over 6K!
If you have a problem with a bill, it is ultimately your insurance company that decides which charges it will and will not cover. They can deny just about anything, for any reason, and there is nothing you can do about it.
Medicare Advantage plans may not continue year after year. But every year, you need to pick a new MA/MAPD plan. If you like your plan, AWESOME, but it may not be around next year, and if that happens, you must pick a new plan.
If your allowance for Eyewear (Prescription Glasses or Contacts) does not cover it, do not wait until October to go to the Optometrists. Why? Because your $250 benefit is really only $62.50 per quarter. The best thing to do is to try to beat the insurance company at its own game. So, on the last day of the quarter, use your benefits for the Optometrist appointment. Eye Exam. Then, use the first day of the new Quarter to pay for your benefits.
If you have an HMO plan, you only have FULL Coverage in the county where you reside. Anytime you travel outside of your home county, you only have "Covered" Healthcare at an URGENT Care facility or in a Hospital Emergency Room. And as soon as they put you in a Hospital Room, you will be responsible for paying all out-of-network costs associated with your stay.
Most Medicare Beneficiaries receive better care and more benefits if they qualify for a Medicare SPN (Special Needs Plan) or a C-SNP (Critical Special Needs Plan) than with a regular MAPD plan.
Most Doctors, healthcare providers, and first responders often refer to Medicare Advantage plans as Medicare Dis-Advantage.
WRAPPING THINGS UP
Photo of Michael Braden's Business Card. Braden Medicare Insurance is a Licensed, Independent Medicare Broker and a CMIP (Certified Medicare Insurance Planner). We are based in Chandler, AZ, and are also licensed in California, Colorado, Florida, Indiana, Iowa, Michigan, Nevada, New Mexico, Ohio, Oregon, Pennsylvania, Texas, and Wisconsin.
If you have any questions, would like a second opinion, or have a question about Medicare, please feel free to reach out to us anytime. We will never charge a penny for our time, knowledge, or expertise. Email us @ mike@bradenmedicare.com, call or text us @ (480) 225-1393, or visit us on our website at www.bradenmedicare.com anytime, 24/7.
