July 12th 2024
By Ari Parker
Learn about restrictions and limitations that may lead to some people leaving their Medicare Advantage plans.
By Ari Parker
Enrollment trends for Medicare Advantage plans have steadily increased over the last decade, with 51% of eligible Medicare beneficiaries now enrolled in one. Despite their popularity, you may know someone who wants to leave their plan. In fact, a recent study found that about 50% of people who enrolled in a Medicare Advantage plan between 2011 and 2020 left their contract after five years.
Medicare Advantage plans are heavily marketed, and the extra benefits are appealing. However, many beneficiaries find these plans more limiting and expensive than they anticipated. In this blog post, we’ll explore common frustrations with these plans and what to look out for.
People leave Medicare Advantage plans because out-of-pocket costs vary between plans, network restrictions can cause frustration, prior authorization requests can delay care, and it can be difficult to use the additional benefits they provide.
You can leave a Medicare Advantage plan and switch to a different policy or come back to Original Medicare.
If you want to leave your Medicare Advantage plan, a Chapter Medicare Advisor can help you understand your options and enroll in the best plan for your healthcare needs.
Medicare Advantage plans are bundled alternatives to Original Medicare, offered by private insurance companies. Original Medicare consists of two parts: Part A, which covers inpatient services, and Part B, which mainly covers outpatient services. People with Original Medicare also have the option to enroll in a separate insurance for their prescriptions (Part D).
Medicare Advantage plans combine Part A, Part B, and often Part D into a single health insurance plan, similar to coverage you might have had through an employer or other group health insurance. These plans also usually include additional benefits beyond what Original Medicare offers, such as coverage for routine dental, vision, and hearing services. Many Medicare Advantage plans also have $0 premiums. While you’re still responsible for your Part B premium, additional benefits for no extra monthly cost sounds great!
So what’s the catch? A bundled Medicare health plan that provides extra perks sounds convenient and cost-effective. While Medicare Advantage plans can be a good option for some, many beneficiaries have found these plans frustrating for several reasons. Below are some common complaints about Medicare Advantage plans.
It can be difficult to shop for a Medicare Advantage plan because there’s a lot of variation between policies. All Medicare Advantage plans must cover everything that Part A and Part B cover, but insurance carriers can set their own copay and coinsurance amounts for covered services. Additional benefits and their value also vary between Medicare Advantage plans. For example, some plans may include transportation to medical appointments, while others do not.
So, costs and benefits aren’t standardized and depend on the individual policy. This lack of standardization can frustrate beneficiaries who are billed more than they expected or realize other plans could save them more on their healthcare costs.
Network restrictions may be a familiar frustration for people who have had group health insurance in the past. Medicare Advantage plans operate with provider networks, meaning you’ll only get full coverage if you see healthcare providers within your plan’s network. If you see providers outside this network, your out-of-pocket costs will be higher. These restrictions are particularly inconvenient for seniors who travel often or need care from an out-of-network specialist.
Medicare Advantage plans often require prior authorization, which means you need approval from your insurance carrier for certain services. While you can appeal a denied request, this process can delay your care. If your insurance denies the appeal, you may have to cover the full cost of the service yourself.
The additional benefits included in some Medicare Advantage plans can be challenging to use. For example, many plans offer over-the-counter (OTC) credits, which are monthly or quarterly allowances for items like aspirin or sunscreen.
While helpful, insurance providers have their own systems and rules for how beneficiaries can use their OTC benefit cards. Additionally, Medicare Advantage plans may not have an intuitive way to track spending or reminders to use the amounts before they expire. If you need help managing your OTC benefits, Chapter’s free OTC app can make it easy!
Although there are reasons why people may leave their Medicare Advantage plans, they also could work for some beneficiaries. Here are some positive aspects of Medicare Advantage plans:
Many plans offer $0 premiums and include prescription coverage
Most plans have out-of-pocket maximums that protect you against catastrophic healthcare costs
Special Needs Plans can be beneficial for people who qualify
Additional benefits, such as coverage for dental, vision, and hearing services, can be useful
If you’re shopping for Medicare Advantage plans, make sure you compare plans and understand the differences between out-of-pocket costs and added benefits. If you end up choosing a Medicare Advantage plan that doesn’t work for you, you can switch policies or return to Original Medicare during specific enrollment periods.
You have a few opportunities throughout the year to leave your Medicare Advantage plan and switch to another plan.
Medicare annual Open Enrollment Period
The Medicare Open Enrollment Period occurs from October 15th to December 7th every year. During this time, you can:
Switch to another Medicare Advantage plan
Switch back to Original Medicare
Add, drop, or change Medicare prescription drug plans
Medicare Advantage Open Enrollment Period
The Medicare Advantage Open Enrollment Period runs from January 1st to March 31st each year. This period allows you to switch plans if the one you chose doesn’t suit your needs. During this time, you can switch to another Medicare Advantage plan or return to Original Medicare.
Special Enrollment Periods
If you experience a qualifying life event, you can switch Medicare Advantage plans or switch back to Original Medicare during a Special Enrollment Period. For example, if you move out of your plan’s service area, you qualify for a Special Enrollment Period and can switch to a different Medicare Advantage plan.
Important note: If you choose to switch back to Original Medicare, you may no longer have the option to enroll in a Medicare Supplement (also called Medigap) plan to limit your out-of-pocket costs.
You are only guaranteed acceptance into a Medicare Supplement plan during your Medigap Open Enrollment Period, which occurs when you’re first eligible for Medicare. Outside of this period, you’ll likely need to undergo medical underwriting, and insurance companies may deny your Medigap application or charge you more based on your health history.
This is why many seniors who initially enrolled in a Medicare Advantage plan opt to switch to another Medicare Advantage plan that better suits their needs.
Medicare can be complex, and its many moving pieces make finding the right plan challenging for many. Chapter Medicare Advisors focus on your priorities to make Medicare enrollment simple and quick! Call an agent today at 855-900-2427 or schedule a time to chat to understand your options, compare plans, and enroll in insurance that works for you.
