Why Are People Leaving Medicare Advantage Plans?

People saying "bye" and people leaving their medicare advantage plan

Medicare Advantage plans are becoming increasingly popular every year. They are advertised on just about every TV station, and we bet you’ve even received a flyer or two in the mail. However, opinions on whether Medicare Advantage is good or bad are split. Some people love them, and others hate them. So, why are some people leaving Medicare Advantage plans? We’re going to answer that question today.

What Are Medicare Advantage Plans?

Medicare Advantage plans, also called Medicare Part C, offer an alternative way to receive benefits otherwise provided by Parts A and B. Part C plans combine all the benefits from Parts A and B, add some extra coverage, and create one convenient plan.

Private insurance companies sell Medicare Advantage plans, but the plans must follow certain guidelines and are regulated by the Centers for Medicare and Medicaid Services (CMS). There are several different types of Medicare Advantage plans. Two popular options are Preferred Provider Organization (PPO) and Health Maintenance Organization (HMO) plans.

Most Part C plans use provider networks to keep their costs low. If you see providers that don’t contract with your particular plan, you’ll be left with higher out-of-pocket costs or even the entire bill. Before you enroll in Medicare Advantage, take the time to understand the different kinds of these plans.

Disadvantages of Medicare Advantage

Opinions are very divided when it comes to Medicare Advantage. It works well for some people and not so well for others. Nothing in Medicare works for everyone, so before you take the opinion of others as the truth, you should do your own research and learn what you can about Part C. There is a lot of misinformation out there. Let’s talk through a few of the disadvantages that may cause beneficiaries to leave Medicare Advantage plans.

First, one of the things that attract people to Medicare Advantage plans in the first place is all the extra benefits. While every plan is different, nearly all of them offer benefits you won’t get in Original Medicare (Parts A and B). This sounds great, and it is, but it can often be hard to use those benefits. You may have trouble finding providers that accept them, and you may find them cumbersome to use. For example, a plan may offer an over-the-counter stipend but require you to use a specific mail-order catalog. 

post-it note asking if it's time to leave a medicare advantage plan

Plus, many advisors will focus on the medical benefits, which they should. They’ll ask you about your primary care physician and other specialists so that they can be sure they participate in the plan. However, they often forget to ask about the providers of extra benefits, like your preferred dentist. If they’re out-of-network, you may not have coverage.

Another reason some people choose to leave their Medicare Advantage plan is because of the networks we discussed earlier. Under Original Medicare, you can see any provider that accepts Medicare. Considering that about 96% of all providers accept Medicare, this is usually not an issue. Medicare Advantage plans, on the other hand, are much more restrictive.

It’s important to understand how each plan works but to give you an idea, let’s look at the most popular Medicare Advantage plans. PPO plans do allow for some coverage outside of the network, but you’ll pay higher out-of-pocket costs when you do so. HMO networks don’t offer any out-of-network coverage except in emergency situations. Networks can change annually, so you’ll have to check your provider’s participation every year. This can also make it difficult if you are someone who travels frequently and may need to find doctors in multiple states.

Medicare Advantage plans also require many more prior authorizations than Original Medicare. Certain treatments and procedures may require prior authorization before you can get treatment. This is designed to ensure providers are offering less invasive, less expensive treatment first, but it can also lead to delayed care and lots of paperwork.

Depending on what kind of Medicare Advantage plan you have, you may also be required to obtain a referral before you see a specialist. This results in even more appointments and delayed treatment.

Get Help with Medicare Advantage 

Whether you want to enroll in Medicare Advantage or a Medigap plan, our advisors are here to assist you. We can discuss the pros and cons of each option and ultimately help you decide which one is right for you. This is not a decision you should make lightly. It’s important that you work with a seasoned agent to make sure you’re getting the coverage you need.

Reach out today to speak with a Medicare advisor near you!