Suze Orman’s Essential Warnings for Medicare Advantage Enrollees Right Now
If you or a loved one is enrolled in a Medicare Advantage plan, you might be feeling pretty good about your health coverage. These plans often boast low monthly premiums and tempting “extras” like vision or dental coverage. But according to personal finance icon Suze Orman, that comfort could be an illusion. She has a clear message for everyone with an Advantage plan: You must pay attention to the fine print, especially during this open enrollment period.
Orman stresses that the biggest mistake people make is choosing a plan based solely on its upfront cost or those “free” add-ons. Instead, she urges people to focus on one critical factor: the potential cost and quality of care if you were to become seriously ill. That means obsessing over the provider network.
Unlike Original Medicare, an Advantage plan restricts you to a network of doctors and facilities. If you need specialized care and that specialist or hospital is not in-network, you will face much higher out-of-pocket costs, or the care may not be covered at all. Orman’s warning is simple: Be a smart shopper, and prioritize the network over a few dollars saved on a premium.
The Crucial Annual Checkup
For current enrollees, this is not the year to simply let your plan roll over. Major insurers, including two of the largest in the market, have announced that they are terminating or consolidating some Medicare Advantage plans for 2026. This means even if you do nothing, your coverage will change, potentially resulting in higher out-of-pocket costs or a completely different provider list. You should have already received your Annual Notice of Change, and Orman insists you need to read it cover-to-cover.
Prescription drugs are another area that requires extra scrutiny. While the news is good for some—starting in 2025, there is a new $2,000 cap on what enrollees must pay out of pocket for covered prescription drugs—this change has a side effect. Orman warns that to offset the cost of that cap, insurers may increase monthly Part D premiums or change which drugs they are willing to cover. You must confirm that your current prescriptions are still covered at an affordable rate.
Don’t Accept “No” For an Answer
Perhaps Orman’s most actionable tip for anyone dealing with the Advantage system relates to coverage denials. Many Advantage plans require pre-authorization for big-ticket medical procedures. If your insurer denies your request for care, Orman says that doesn’t mean it’s a final denial.
Citing data from the Kaiser Family Foundation, Orman points out that when patients take the time to appeal an initial denial, the insurer reverses its decision in more than 80% of cases. Unfortunately, a vast majority of people never file that appeal, effectively letting the insurer start at “No” and save money. If you or a loved one is denied necessary care, be persistent and file that appeal.
Ultimately, Orman wants people to be realistic about the trade-offs. Advantage plans cap your out-of-pocket costs (for example, the maximum for in-network care in 2025 was $8,850), while Original Medicare, by itself, has no annual limit on your 20% co-insurance. However, for people who can afford it, combining Original Medicare with a separate Medigap policy and a Part D drug plan offers maximum flexibility to see any doctor in the country who accepts Medicare—a level of choice Orman says can be priceless during a serious health crisis.
