Today I want to answer a common question people have, why are people leaving Medicare Advantage plans? Feel free to read the article or watch the video that’s included on this page. If you find it helpful, feel free to pass it along to a friend.
What is Medicare Advantage?
If you’re not familiar with Medicare Advantage, Medicare Advantage is simply another way to receive your Medicare benefits. As far as the parts of Medicare go, it’s known as Part C of Medicare, and it’s very appealing to many people because of the additional benefits that it provides that Original Medicare doesn’t. Things like vision coverage, dental coverage, hearing coverage, and gym memberships. Some of them even give you meals, and there are flex cards for groceries. They’re marketed very heavily, especially in the fall around the Annual Enrollment period for Medicare.
1. Limited Provider Networks
One of the primary reasons I think people are leaving Medicare Advantage plans is the network restrictions. When you have a Medicare Advantage plan, usually it’s an HMO or a PPO, and you have to agree to stay within that plan’s network of providers. This would include doctors, specialists, clinics, and hospitals. If you sign up for a Medicare Advantage plan, please make sure that the agent that you work with is double-checking that all your providers are in the network, because there’s nothing worse than signing up for a plan, going to your doctor’s office and having them tell you, “we don’t take this plan.”
The network restrictions are one of the biggest reasons I think people want to leave a Medicare Advantage plan. If you have Original Medicare, which is your Part A and B, you can go anywhere in the country that accepts Medicare, and that is a very large network, as you can imagine.
2. Annual Plan Changes
Another big reason why I think people are leaving Medicare Advantage plans is the annual changes. If you have a Medicare Advantage plan it changes every year. The carrier has to send you the details of the changes within your plan for the coming year. There are always changes, whether it’s how much a service is covered, how a drug is covered, or even changes with the providers. If you have a Medicare Advantage plan, be sure to review the Annual Notice of Change letter that you receive in the mail before the Open Enrollment period in the fall.
Also, it seems that almost every year as a Medicare agent, I see news stories about providers who stop accepting Medicare Advantage plans. This usually happens when providers and insurance companies can’t agree on a contract before the start of a new year.
3. Out-of-Pocket Costs
Another reason why I believe people leave Medicare Advantage plans is that they signed up for a plan because of the very low monthly premium not realizing there can be out-of-pocket costs for things like copayments, deductibles, and coinsurance. Also, each Medicare Advantage plan has what’s called a Maximum out-of-pocket limit, similar to a traditional health plan deductible. Depending on your Medicare Advantage plan, it could be several thousand dollars over the year. Even though you may pay little to no premium, you could have other costs that you weren’t expecting.
4. Limited Geographic Coverage
The growing reason I hear from people who are less interested in Medicare Advantage plans is the limited geographic coverage. If you are in a larger metro area, then there are usually a lot more providers, and the Medicare Advantage companies compete very heavily for your business, so it’s beneficial for them to have a larger network. However, if live in a more rural area, then finding a doctor, clinic, or hospital in the network can prove more challenging leading to concern over receiving care.
5. Complex Rules and Prior Authorization
Another big reason some folks want to go back to Original Medicare away from Medicare Advantage is the complexity. Each Medicare Advantage plan has its own rules, regulations, and prior authorizations of the requirements. There’s nothing more frustrating than having to go to a provider only to find out that your insurance company requires prior authorization or approval for care.
6. Lack of Understanding at Signup
The final reason I think many people want to leave a Medicare Advantage plan is they didn’t know what they got when they signed up the first time. Maybe someone called them on the phone and they just went with whatever Medicare plan was offered, not realizing what they signed up for. This is why you should be very careful when people call you on the phone about Medicare or Social Security. I’ve had people tell me that someone they talked to on the phone switched their plan without their consent. It’s so important to educate yourself to know the difference between Original Medicare and Medicare Advantage before you talk to anyone.
Can I Switch From a Medicare Advantage Plan Back to Original Medicare?
The one thing to keep in mind if you want to leave a Medicare Advantage plan is that you can usually only do it during certain times of the year. The other thing to keep in mind is that Original Medicare has a 20% gap in coverage with no limit. You probably don’t want to switch off a Medicare Advantage plan unless you know you can qualify for a Medicare Supplement plan. Keep in mind, that if you’re outside your initial Open Enrollment for a Medicare Supplement plan (Medigap), you’re most likely going to have to go through medical underwriting to qualify and the insurance company can reject your application. If you do have some health issues, you will want to tell your agent or broker about that and they should be able to help determine your eligibility.
If you have questions about Medicare or you would like a free review of your coverage, feel free to reach out.
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Jamie, a licensed insurance agent specializing in Medicare plans, life insurance, and dental insurance. |