Why Are People Leaving Medicare Advantage Plans? Exploring Key Reasons

Choosing the right Medicare plan can be exhausting. But don’t worry, it doesn’t have to be. However, you should understand why people are leaving Medicare Advantage plans and going back to Original Medicare. This will help you make the best choice for your healthcare needs.

We will explore the most common reasons why some folks are ditching Medicare Advantage by exploring the pros and cons of these plans. Original Medicare and Medicare Advantage plans both have benefits, but some people find one fits their needs better than the other.

So, why are people leaving Medicare Advantage plans?

Why are people switching away from Medicare Advantage?

There are quite a few reasons why folks choose to leave Medicare Advantage. Let’s take a look at some of the most common ones. Considering the experiences and needs of those who have chosen to switch back to Original Medicare is important. Understanding their reasoning can help us gain a clearer perspective.

Limited Network Options

Most Medicare Advantage plans require you to use their network of healthcare providers. If you love seeing a particular specialist, they may not accept your Medicare Advantage plan. This means finding new doctors and not getting the continuity of care you prefer.

Navigating Referrals and Prior Authorizations

Many Medicare Advantage plans need referrals for specialty care. Imagine this: you need to see a specialist. It might take some time to get approved, even if it’s for something really important.

These delays and the hassle of paperwork sometimes frustrate Medicare Advantage members.

Rising Out-of-Pocket Costs

Even though Medicare Advantage plans seem more budget-friendly initially because their monthly premiums can be lower than traditional Medicare, there’s a catch. It can get confusing when the bills start rolling in.

This is because copays and coinsurance costs can add up. Plus, these out-of-pocket costs could go up if your plan changes. The Physicians for a National Health Program have calculated that the program could cost Medicare upwards of $140 billion annually. So, while Medicare Advantage premiums might initially be low, the overall cost might be higher.

Plan Changes Every Year

Medicare Advantage plans have annual changes to premiums, benefits, copays, and sometimes, provider networks. Imagine going to your favorite doctor and finding out that he or she is not in your plan anymore. You’ll need to either switch doctors or switch plans.

This instability frustrates seniors, who seek plans with consistent coverage and provider choices. They often consider traditional Medicare as their health policy.

Difficulty Switching Back to Original Medicare

Switching from Medicare Advantage back to Original Medicare is not always smooth sailing, especially if you want a Medigap plan. Medigap is designed to cover costs that Original Medicare doesn’t cover fully.

The tricky part is that in 46 states, Medigap insurance companies can deny coverage to Medicare beneficiaries because of health conditions you already have if you’re switching from Medicare Advantage. This can leave you feeling stuck.

What’s the Appeal of Original Medicare?

If many people are leaving Medicare Advantage, there has to be a good reason. And it is simply this: Original Medicare benefits have significant advantages for people needing healthcare in their golden years.

The freedom to choose any provider nationwide who accepts Medicare is super convenient. You can visit any specialist or get care from any hospital without restrictions.

With Medicare Advantage, if a certain doctor or facility isn’t part of your plan’s network, you may not have coverage or face high costs. However, unlike Original Medicare, Advantage plans do have an annual maximum out-of-pocket limit, and most include extra benefits, such as a prescription drug plan.

Predictable Coverage and Costs

Traditional Medicare is great because you usually know your cost-sharing responsibility. Once you meet the annual deductible for Medicare Part B, you typically pay a fixed percentage, around 20%, for covered services.

You can avoid the unexpected high medical expenses that might crop up with some Medicare Advantage plans, especially with Medigap supplemental coverage to help handle your costs. A Medigap policy is a smart option, working together with Original Medicare to provide broad nationwide coverage and predictable costs, which provides more peace of mind.

Enrollment Periods

Once you’re enrolled in Medicare Part A and Part B you’re enrolled. You don’t have to worry the mad rush of the Annual Enrollment Period (AEP). This is the open enrollment period in the fall when new Medicare Advantage plans come out.

Medicare Advantage enrollees need to check their plan every year to see what coverage or providers were dropped, what prices increased, how their drug coverage changed, and what the new out-of-pocket limits will be. For some people, it can me a real nightmare.

Looking at Both Sides of the Coin

Now, let’s flip the script and look at what a Medicare Advantage plan actually does. It’s popular because it covers hospital stays (Medicare Part A) and medical services (Medicare Part B). Plus, they often include extra benefits, such as prescription drug coverage.

Some people choose Medicare Advantage for its additional perks, which traditional Medicare doesn’t have. Medicare Advantage plans aim to create a well-rounded, budget-friendly option that includes extras like vision care or dental checkups.

This leads us to the main question: why are people leaving Medicare Advantage plans?

Switching away from Medicare Advantage plans could be influenced by several factors. A 2023 study published in the JAMA Health Forum showed approximately half of enrolled beneficiaries leaving their plans before five years. This emphasizes that deciding between Medicare Advantage and Original Medicare boils down to your needs. Are you looking for wider choices of doctors, clear, predictable costs, or the ease of simpler coverage? Your preference for those things will guide you.

As more seniors express concerns and some opt to switch back, the landscape of Medicare choices is changing. For instance, to address concerns about network access, starting this year, 2024, all new or growing Medicare Advantage plans must show they meet network requirements to be considered for approval. It seems policymakers and health systems are recognizing some areas for improvement.

Making The Choice Right for You: Traditional Medicare or Medicare Advantage?

You’ve probably heard many opinions, and you’re left wondering how to choose between Medicare Advantage and traditional Medicare. It is important to consider your healthcare preferences and what’s important to you. Think about whether having access to a wide range of providers is more valuable than additional benefits. If having predictable coverage and costs matters more than extra perks, you know what’s better for your situation.

Let’s say freedom in healthcare is super important. Maybe you travel often. Then, traditional Medicare with Medicare Supplement Insurance might be a great choice because you’d have access to healthcare nationwide and be protected against high healthcare bills. But, if you need dental, vision, and hearing coverage and prefer an all-inclusive plan, then sticking with Medicare Advantage makes more sense.

This boils down to considering your health needs, how comfortable you are with out-of-pocket expenses, how significant those extra benefits are, and how much you need consistent care from familiar doctors. Once you consider all this, it’s wise to explore plan options each year during the Medicare Open Enrollment Period to ensure your current choice aligns with your evolving health needs and priorities.

FAQs about why are people leaving Medicare Advantage plans?

FAQ 1: Why do people say not to get a Medicare Advantage plan?

Some advise against Medicare Advantage plans due to issues like restricted provider networks, potentially higher out-of-pocket expenses down the line, and annual plan changes, creating uncertainty for long-term care.

FAQ 2: Why do hospitals not like Medicare Advantage plans?

Some hospitals find Medicare Advantage plans tricky because reimbursement rates are sometimes lower. In addition, prior authorization requirements create administrative hassles and can delay treatment.

FAQ 3: What is the scandal about Medicare Advantage?

Criticisms around Medicare Advantage often involve accusations that some private insurance companies intentionally overbill Medicare. These issues are often framed in a manner that resembles a scandal, potentially fueling concerns. For example, research by Physicians for a National Health Program concluded that this alleged overbilling might cost the Medicare program as much as $140 billion annually. This, combined with accounts of restricted care and approval hurdles, feeds into public concern.

FAQ 4: Why are people leaving Medicare Advantage programs?

The main reasons are the need for more freedom in choosing doctors (which you have with original Medicare), unexpected higher out-of-pocket costs down the line, constant changes to plans every year, and complications switching back to Original Medicare. People value flexibility and knowing their costs in advance, which Original Medicare can provide.

Conclusion

The choice between Medicare Advantage and Original Medicare is personal. There is no universal ‘better’ plan, it depends on you. Understanding why people are leaving Medicare Advantage plans helps you evaluate what truly matters for your healthcare. Consider what we have explored. Does consistent access to specific doctors or predictable costs matter most? Your preference and health situation guide your decision.