August 14th, 2025 – Seniors in Colorado are bombarded with television ads, glossy mailers, and phone calls all promising a better deal on their Medicare coverage through a Medicare Advantage plan. They highlight dental, vision, and hearing care, gym memberships, cash cards, and other perks that sound terrific at first glance.

The marketing paints a rosy picture — but does the reality match the promise?

The Fine Print Behind the Perks

Many of these extra benefits look impressive at first glance. But dig a little deeper, and the limitations become clear. That dental plan? It might come with a $160 Annual Maximum — not enough to cover even a single cavity. “Broad provider choice” may actually mean a small network of doctors and hospitals, with outdated directories that still list physicians who no longer participate.

Some of the flashiest benefits are only available to people who qualify for both Medicare and Medicaid — a group known as “dual-eligible” beneficiaries. These individuals often bring higher reimbursement rates from the federal government, making them highly profitable for insurance companies.

Also, as the feds put the squeeze on the Medicare Advantage insurers, you can be certain to see the value in their “value adds” get further squeezed in the very near term.

Dental, Vision & Hearing Needs Often Still Go Unmet

The Centers for Medicare & Medicaid Services (CMS) funnels nearly $20 billion a year into supplemental benefits for Medicare Advantage plans. Yet many enrollees, particularly those with lower incomes, still report they can’t afford dental, vision, or hearing care. Low annual limits, high copays, and sparse provider networks can turn “included benefits” into inaccessible ones.

Narrow Networks Mean Limited Choice

Unlike traditional Medicare — which lets you see almost any doctor who accepts Original Medicare — Medicare Advantage plans often operates within a narrow provider networks. This can mean far fewer specialists and hospitals to choose from and the risk that the narrow networks might get even narrower. In some states, entire provider systems are dropping out of some Medicare Advantage plans.

The Roadblocks of Prior Authorization

Medicare Advantage makes liberal use of prior authorization — the insurer’s requirement to approve certain services or treatments before you receive them. Over 90% of Medicare Advantage plans use this for everything from lab tests to hospital stays. For medications administered in a doctor’s office, the rate is even higher at 98%. The result? Delays, denials, and extra paperwork — barriers you don’t face with original Medicare and Medicare supplements.

Drug Restrictions and “Fail First” Rules

Medicare Advantage plans often control costs with strict drug lists (formularies) and “step therapy” rules — requiring patients to try cheaper drugs and prove they’ve failed before getting the one their doctor originally prescribed. While this may save insurers money, it can delay access to the most effective treatments and add frustration for both patients and providers.

The Bottom Line: Medicare Advantage can work well for some people, especially if their doctors are in-network and they don’t need specialized care. But it’s worth looking beyond the marketing. Ask questions, compare options like Plan G Medicare Supplements that work with Original Medicare, and make sure the Medicare Advantage plan’s network, drug coverage, and benefits truly match your needs.