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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 several benefits, including those covered by Original Medicare and more.

However, the fact that a plan covers these services, does not necessarily mean that the coverage is comprehensive or to the level you require. 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. 

Often, people refer to Medicare Advantage plans as all-in-one plans because they include additional benefits not covered by Medicare Part A and Part B. Yet, these promises for additional services are a major reason people end up leaving Medicare Advantage plans.

When you enroll in a Medicare Advantage plan, you often give up the freedoms that come along with Original Medicare in exchange for these additional benefits. These freedoms include the right to see any doctor you choose and receive specialty care without a referral. Once enrolled, 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.

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With these limits, you could end up footing the bill for care even though you thought your plan would cover the services. Additionally, plan benefits 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 
  • Hospital Stay
  • Radiology Services 
  • Lab work services
  • X-Rays 

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. 

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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.

Jagger Esch

Jagger Esch

Medicare Educator
Jagger Esch is the Medicare Educator 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.
Ashlee Zareczny

Ashlee Zareczny

Compliance Manager
Ashlee Zareczny is the Compliance Manager for MedicareFAQ. As a licensed Medicare agent in all 50 states, she is dedicated to educating those eligible for Medicare by providing the necessary resources and tools. Additionally, Ashlee trains new and tenured Medicare agents on CMS compliance guidelines. Ashlee is a Medicare expert who specializes in Medicare Supplement, Medicare Advantage, and Medicare Part D education.

10 thoughts on "Top 3 Reasons Why People Leave Medicare Advantage Plans"

  1. My husband is 61 yo and currently employed. I am 74, retired, use his insurance primary and Medicare secondary. I’m sure there is a better way but am not sure how to make a better choice. Can you suggest how to get started?

    1. Hi Kathleen, another option for you may be to drop your husbands employer coverage, use Original Medicare as primary and enroll in a Medicare Supplement plan as secondary insurance. However, before doing this, it is essential to compare the benefits to determine which route is best for you.

  2. You’ve been helping us with medicare inf for 4-5 years. You’ve been very helpful and ßaved us money. We’re not changing this year but will continue to contact you for future help. This month’s news letter was really helpful explaining medicare vs Medicare advantage. Keep up the good work!

    1. Hi Bonnie,
      Thank you for the kind comment! We appreciate our clients and do the best we can to ensure your happiness in your Medicare coverage each year. I’m glad you enjoy the monthly newsletter, our team works very hard to provide you with educational content each month!

  3. I was on Traditional Medicare with a Medigap plan. I switched to Aetna Medicare Advantage. The Aetna MA plan is very unsatisfactory. What would be the costs in moving back onto Traditional Medicare with a Medigap plan.

    1. Hi Anne, to re-enroll in your Medicare Supplement plan, you have a few options. If you have been on your Advantage plan for less than one year, you can use a Special Enrollment Period (trial right) to disenroll from your Advantage plan and back to your Medigap plan with no health questions. If it has been longer than 12 months you’ll need to make the change before December 7. Either way, you’ll need to work with an agent to get your application in a timely manor. Complete our online rate form to see quotes for Medigap plans in your area.

  4. I retired in March 2016 and decided to go with the Humana Advantage plan. Recently I’ve been talking with a friend who has the supplemental plan. I don’t spend as much in co-pays as she does in premiums but I’ve started asking questions (to myself) like what would happen if I wanted to go to a specialty hospital. Also, my medical health has changed some. Will that keep me from being able to change from the advantage plan to the supplement plan? Is there any way to get a copy of the health form that I would need to fill out? Thank you.

    1. Any health-related issues put you at risk of being denied a Medicare Supplement plan. This is why it is essential to enroll early and while you are healthy. Unfortunately, there is no generic health form to complete, each carrier asks it’s own set of underwriting health questions. Thus, a condition may be denied under one carrier but not another. The best way to understand if you qualify for Medicare Supplement is by speaking with an agent who can provide you with all of your options.

  5. 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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