Why Are People Disenrolling from Medicare Advantage Plans?

Navigating health insurance can be complex, especially when it comes to understanding Medicare and its various plans. Recently, there has been an uptick in the number of individual disenrolling from Medicare Advantage plans, and this trend has raised some eyebrows. If you’re currently on Medicare or considering your options, it’s crucial to understand the reasons behind this shift.

What is Medicare Advantage?

Before we dig into why people are disenrolling, let’s clarify what Medicare Advantage is Medicare Advantage, also known as Medicare Part C, offers an alternative way to receive your Medicare benefits. These plans are offered by private insurance companies approved by Medicare and often provide additional benefits beyond Original Medicare (Part A and Part B),such as vision, dental, and wellness programs.

Common Reasons for Disenrolling from Medicare Advantage

1. Limited Provider Networks

One of the primary reasons people choose to leave Medicare Advantage plans is due to limited provider networks. Unlike Original Medicare, which allows you to see any doctor who accepts Medicare, Medicare Advantage plans often require you to use a network of doctors and hospitals. If your preferred healthcare providers are not in the network, this could limit your access to the care you need.

2. Unexpected Out-of-Pocket Costs

Though Medicare Advantage plans often have lower premiums than Original Medicare combined with a Medicare gap policy, out-of-pocket costs can be higher. Co-pays, co-insurance, and deductibles can add up quickly, catching some enrollees off guard. For many, these unexpected expenses become financially burdensome, leading them to disenroll.

3. Coverage Limitations

Medicare Advantage plans must cover all the services that Original Medicare covers. However, the way they cover these services can differ. Some plans may require prior authorization for certain procedures, or they might have more restrictive coverage policies for specific treatments. These limitations can be frustrating and inconvenient, prompting some to switch back to Original Medicare.

4. Changing Health Needs

Health needs can change over time. What worked for you a few years ago might not be ideal now. If you develop a chronic condition or require specialized care, you might find that your Medicare Advantage plan no longer meets your needs. This could be a significant factor in deciding to disenroll and seek alternative coverage.

5. Lack of Satisfaction with Plan Performance

Customer satisfaction plays a vital role in healthcare. Many people disenroll from Medicare Advantage plans because they are dissatisfied with the plan’s performance, whether it’s due to poor customer service, delays in receiving care, or issues with claims processing. High satisfaction rates are often associated with better health outcomes, making this a critical consideration.

6. The Annual Disenrollment Period

Lastly, it’s worth mentioning that the Medicare Advantage Disenrollment Period (January 1 – February 14) provides an opportunity for individuals to leave their Medicare Advantage plan and return to Original Medicare. This period allows beneficiaries to reassess their healthcare needs and make changes if they feel their current plan isn’t serving them well.

Is Disenrolling the Right Choice for You?

While there are valid reasons for disenrolling from a Medicare Advantage plan, it’s essential to carefully evaluate your options. Consider factors such as:

● Your healthcare needs: Do you require specialized care that your current plan doesn’t adequately cover?
● Costs: Are out-of-pocket expenses manageable within your budget?
● Provider access: Are your preferred healthcare providers within your plan’s network?
● Plan benefits: Does the plan offer additional benefits that you find valuable?

Frequently Asked Questions

Are All Doctors Covered By Medicare Advantage Plans?

No, Medicare Advantage Plans Have Doctor/Hospital Networks that must be checked prior to enrollment.

Are All Medications Covered by Medicare Advantage Plans?

No, Medicare Advantage Plans have a list of Covered Medications called a Formulary that can be different between plans.

Are all Medicare Advantage Plans the Same?

No, While the overall coverage is similar there are differences in covered Medications, Doctor/Hospital networks and Copays.

Do Medicare Advantage plans require a Referral to see a Specialist?

Yes/No, If your Medicare Advantage Plan is an HMO, you may need a Referral(Most have eliminated that requirement) but if you are enrolled in a PPO a Referral and primary Care choice is not necessary.

Mike Miligi- Owner

For over 10 years, Mike has been assisting Seniors and other Medicare-eligible individuals in understanding the ins and outs of Medicare and Medicare Health Insurance options, including Medicare Advantage Plans(Part C), Medicare Supplement Plans(Medigap), Prescription Drug Plans(PartD), and Dental and Vision programs.

Mike is Licensed in seven States and Certified with 11 Insurance Carriers. He has helped thousands of individuals decide on the best course of action for their particular Health Insurance needs. Because Mike is an Independent Medicare Health Insurance Broker, he works for the client, not the Insurance Carriers, and is able to provide his clients with accurate and unbiased Health Insurance options.

Mike recertifies with CMS(The Centers for Medicare and Medicaid Services) annually, regularly completes Continuing Education Courses required by individual State Insurance Departments, and keeps abreast of industry trends and standards to offer his clients the most up-to-date information.

Choosing the Right Medicare Coverage

Selecting the best Medicare coverage depends on factors like your healthcare needs, budget, and preferred providers. You can choose between:

Original Medicare (Parts A & B): Allows you to see any doctor or
hospital that accepts Medicare but does not include prescription drug
coverage (Part D) or additional benefits.
Medicare Advantage (Part C): Offers bundled coverage with
potential extra benefits but may require using a network of providers.
Medigap (Medicare Supplement Insurance): Helps cover
out-of-pocket costs not covered by Original Medicare, such as
copayments and deductibles.

Key Medicare Enrollment Periods

It is crucial to enroll in Medicare at the right time to avoid penalties and ensure continuous coverage:

Initial Enrollment Period (IEP): A seven-month window starting
three months before your 65th birthday month.
General Enrollment Period (GEP): From January 1 to March 31
each year for those who missed their IEP.
Annual Election Period (AEP): From October 15 to December 7,
allowing you to switch or enroll in Medicare Advantage and Part D
plans.
Open Enrollment Period(OEP): From January 1 to March 31 for
those who missed AEP and want to make certain changes.
Special Enrollment Period(SEP): Can be used anytime during the
calendar year for those that meet certain criteria such as moving to a
new service area.

Finding Help with Medicare

Understanding Medicare can be complex, but you don’t have to do it alone. Licensed Insurance Brokers, Medicare.gov, and state health assistance programs can provide guidance tailored to your specific needs.

By taking the time to explore your Medicare options, you can make informed decisions that ensure you receive the healthcare coverage that best suits your lifestyle and budget.

Do I have to sign up for Medicare?

It depends upon your current coverage. If you are employed and your employer has over 20 employees then you can delay signing up for Medicare and avoid penalties.

Does Medicare cover Prescription Medications?

No, You will have to enroll in a stand alone Part D plan or a Medicare Advantage Plan(Part C) to get coverage.

I want to be able to go to any doctor/hospital, are there networks with Medicare?

There are no networks with Medicare and most doctors and hospitals accept it. However, Medicare does not cover 100% of services so a Medicare Supplement or Medicare Advantage plans is advisable.