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Top 3 Reasons Why People Leave Medicare Advantage Plans


There are several reasons Medicare Advantage policyholders may decide to leave their plan. Most commonly, their policy does not cover all of the benefits they initially thought it would.

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On the surface, a Medicare Advantage policy seems like thorough coverage. Medicare Advantage plans cover benefits like health, dental, vision, gym memberships, prescription drugs, and more.

However, the fact that a plan covers these services, does not necessarily mean that the coverage is comprehensive. Usually, it is better to enroll in a policy that adequately covers the care you need instead of a plan with minimal coverage for additional services.

Below, we look at the top three reasons beneficiaries leave their Medicare Advantage plans and what to look out for when searching for your next Medicare plan.

Why Do People Leave Medicare Advantage Plans?

While there are many reasons a policyholder may choose to cancel their Medicare Advantage plan, we are going to review the top three. Hopefully, this insight will help you during your Medicare journey to find the right plan.

Top 3 Reasons People leave Medicare Advantage plans:

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

#1 Disappointed with Medicare Advantage Additional Benefits

There are several services Original Medicare does not cover, for which you may want coverage. Some types of coverage Medicare does not include are dental, vision, and hearing aids, as well as prescription drugs.

While Original Medicare may cover oral surgery if necessary, or a pair of eyeglasses due to cataracts, Original Medicare never covers basic dental or vision preventive services. Hence, why people turn to Medicare Advantage plans.

Often, people refer to Medicare Advantage plans as all-in-one plans because they include these additional benefits. Yet, these services are a major reason people end up leaving Medicare Advantage plans.

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When you enroll in a Medicare Advantage plan, you often give up the freedoms that come along with Original Medicare in exchange for the additional benefits. Once they enroll, many beneficiaries realize that the additional benefits have very limited coverage and finding a doctor who accepts the plan in their area can be difficult.

With these limits, you could end up footing the bill for care even though you thought your plan would cover the services. Additionally, plans change annually. So, one year your plan might have fantastic additional benefits, and the next year they can be eliminated entirely.

#2 Medicare Advantage Limited Networks

Network restrictions are another common reason why beneficiaries leave their Medicare Advantage plans. With Medicare Advantage plans, staying within your policy’s network is key to paying the lowest possible costs for health services.

Going out of your network could mean high fees or no coverage. Even with a Preferred Provider Organization plan, you will end up paying more to see doctors that are not in your plan’s network.

On the other hand, Medicare Supplement policyholders can visit any physician that accepts Medicare. So, many beneficiaries leave Medicare Advantage plans and return to Original Medicare so they can see any doctor they wish. Although, if you do not mind doctor and hospital limitations, a Medicare Advantage plan may work for you.

In this case, it is essential to keep in mind that the doctors can leave your plan’s network anytime. Thus, your doctor may be in-network one month, but out-of-network the next.

#3 Unreasonable Cost-Sharing

Another common reason beneficiaries leave their Medicare Advantage plans is because of unreasonable cost-sharing. When you enroll in a Medicare Advantage plan, you must pay attention to your maximum-out-of-pocket spending limits. Medicare Advantage plans often have deductible, copay, and coinsurance amounts that are much higher than Original Medicare with a Medicare Supplement plan.

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

  • Ambulance – Average Copay: $300
  • Hospital Stay – Average Copay: $300 per day for your first six days
  • Radiology Services – Average Copay: $125
  • Lab work services – Average Copay: $100
  • X-Rays – Average copay: $100

The list of copays above proves that if you become ill, your costs can add up quickly. While you may only have a $0 premium with your Medicare Advantage plan, your costs could far outweigh premium savings. A typical Medicare Advantage plan has a maximum out-of-pocket between $7,000 and $10,000.

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What is Driving High Disenrollment in Medicare Advantage?

Medicare Advantage plans with the highest disenrollment rates are more likely to be for-profit (through private insurance companies), have high out-of-pocket costs, and service small areas. These plans also have disproportionate numbers of low-income and disabled enrollees.

To find the right Medicare Advantage plan, you need to do extensive research before deciding on a policy. You will need to understand the deductibles, copays, and benefits.
Also, take into account the network and service area. If you travel often, a Medicare Advantage plan may not be right for you and you could benefit from exploring Medicare Advantage vs. Medicare Supplement plan options instead.

How To Leave Your Medicare Advantage Plan

If you want to change your plan, it is best to contact a licensed agent. Before making any changes, be sure you are in a valid enrollment period.

Whether you stick with Original Medicare, pair it with Medigap, or opt for a Medicare Advantage plan, make sure to do your research first. That is where we come in. We educate you on all your options and help you decide which plan best fits your needs. We work with all the top carriers, so there is no need to make several phone calls.

To contact us, call the phone number at the top of the page. Can’t call now? No problem. Fill out an online rate form now for a rate comparison for plans in your area.

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Jagger Esch

Jagger Esch is the Medicare expert for MedicareFAQ and the founder, president, and CEO of Elite Insurance Partners and MedicareFAQ.com. Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. He is featured in many publications as well as writes regularly for other expert columns regarding Medicare.

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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