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Top 3 Reasons Why People Leave Medicare Advantage Plans


Beneficiaries leave their Medicare Advantage plans for different reasons. Most commonly, the policy isn’t as inclusive as they thought. When you look at the surface of a Part C policy, it seems simple enough—covering things like dental, vision, gym memberships, and more. But just because it covers the services, doesn’t mean that coverage is comprehensive. Usually, it’s better to buy a policy that covers you adequately. Below we’ll look at the top three reasons beneficiaries leave their Medicare Advantage plans.

Why Do People Leave Medicare Advantage Plans

While there are many reasons someone may choose to leave their policy, we’re going to discuss the top 3 reasons beneficiaries leave their Medicare Advantage plan. Hopefully, this insight will help you during your Medicare journey.

Top 3 Reasons People leave Medicare Advantage plans:

  1. Unhappy with the dental benefits
  2. A limited network of doctors
  3. Unreasonable cost-sharing

1. Unhappy with The Dental Benefits

Medicare doesn’t cover dental. But, some emergency jaw services may have coverage through Medicare.

Often, Medicare Advantage plans are considered “all-in-one” plans because they include dental and vision coverage. But, your policy may only cover preventative services.

With these limits, you could end up footing the bill for dental care beyond the cleaning and exam. And, plans change annually.

For example, maybe you join a plan because of the dental benefits. Next year, that same plan could drop those benefits.

You’ll likely pay for your root canals and other dental care. When you shop for dental, be sure to triple-check the benefits.

You may find that buying a separate dental policy makes the most sense.

2. Limited Network of Doctors

Network restrictions are a common reason why beneficiaries leave their Medicare Advantage plans. Going out of network could mean high fees.

Even with a Preferred Provider Organization plan, you’ll pay more to see doctors that aren’t in-network.

But, Medigap beneficiaries can visit any physician that accepts Medicare. Although, if you don’t mind limitations to doctors and hospitals, an Advantage plan may work for you.

Yet, it’s essential to keep in mind that the doctors can leave the network anytime, and plans change annually. So, a policy may be superior coverage for one year, but unsuitable the next.

3. Unreasonable Cost-Sharing

Another common reason beneficiaries leave their Advantage plans is because of cost-sharing. When you join a Medicare Advantage plan, you’ll pay coinsurance and copays along the way.

You may have a $20 copay to visit your doctor at your checkup. But perhaps your doctor sends you to a specialist where you pay a $50 copay.

Maybe that specialist wants to send you for a procedure in which you’ll pay a larger copay or coinsurance. You’ll want to read the fine print.

You can check out your plan’s Summary of Benefits to get a good idea of the types of copays you’ll have.

To give you a better example of copays you may face:

  • Ambulance – $300
  • Hospital stay—$250 per day for your first six days
  • Radiology services – $125 copay
  • Lab work services – $100 copay
  • X-rays – $100 copay

The list of copays above proves that your costs can add up quickly. If you were to get seriously ill, these prices could skyrocket depending on the care you need.

While you may only have a $0 premium with your Advantage plan, your costs could far outweigh that.

Other Potential Reasons Beneficiaries Leave Medicare Advantage Plans

While the reasons above are the most popular reasons people leave their plans, there may be other factors.

Some other common reasons to leave Advantage coverage include:

  • Your health care services may end up costing you quite a bit more
  • Some Medicare Advantage plans aren’t as financially stable and end coverage unexpectedly
  • Emergency care may be hard to come by
  • Some policies have strict rules to follow to get coverage
  • Health care while traveling can be hard to get
  • Plans that provide Part D coverage may limit specific high-cost prescriptions

Why do Beneficiaries Choose Medicare Advantage?

For those under 65 or people that can’t afford Medigap, an Advantage plan could prove beneficial. Since Medicare varies by state, you’ll want to consider your options.

Then, upon turning 65, you can use your Medigap Open Enrollment Period to select Medigap coverage. Or, you can continue trying to find the best Medicare Advantage plan each year.

Why Do People Leave Medicare Advantage When They Get Sick

Difficult access to specialty doctors and hospitals is the leading cause of people leaving Medicare Advantage. Although, some people leave the Part C plan because they find a lower costing policy.

What’s Driving High Disenrollment in Medicare Advantage?

Researchers find that Medicare Advantage contracts with high disenrollment rates are more likely to be for-profit and small. These plans also have a disproportionate amount of low-income and disabled enrollees.

Do You Want to Leave Your Medicare Advantage Plan?

If you want to change your plan, it’s best to use an agent. You don’t want to end up thinking you have coverage or have other issues arise.

Beneficiaries ultimately leave their Medicare Advantage plans for a variety of reasons. You don’t want to regret your choice because of a lack of benefits, network restrictions, or cost-sharing.

Whether you go with Medicare, Medigap, or an Advantage plan, make sure to do your homework.  If you’d like help with choosing a policy, call our team of agents today at the number above.

Can’t call now? No problem, fill out an online rate form to see rates in your area now!

We’re here for you every step of the way on your Medicare journey.

Lindsay Engle

Lindsay Engle is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.

2 thoughts on “Top 3 Reasons Why People Leave Medicare Advantage Plans

  1. I am working with my 91-year-old neighbor (Marie L Raber) she is currently an Aetna part G plan member. She has been a member since 4/2017. She is considering an advantage plan – I have printed off the detailed summary of the benefits of the advantage plan. She cannot locate her current Summary and is unsure of her Aetna G benefits so I wanted to be able to do a side by side comparison of her current or 2021 benefits so she can make an educated decision. I have looked all over the internet to try to find this information and cannot get the detail. Can you send email me the summary of benefits to share with her or the link – if you need any other information or consent from her, Just let me know.

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