3 Reasons Why People Leave Medicare Advantage Plan

December 20, 2022

why people leave medicare advantage plan

Policyholders with Medicare Advantage Plan may opt to quit their plan for a variety of reasons. The majority of the time, their coverage does not cover all of the advantages they previously anticipated.

A Medicare Advantage Plan appears comprehensive at first glance. They provide health, dental, vision, gym memberships, and prescription medication coverage, among other benefits.

However, just because certain services are included by a plan does not always imply that the coverage is exhaustive. Generally, it is preferable to enroll in an insurance that fully covers the treatment you require rather than a plan that provides inadequate coverage for extra services.

In this guide, we’ll look at why beneficiaries opt to quit their Medical Advantage Plans, as well as what you need to keep in mind when looking for a Medicare plan. 

Let’s get to it.

Why Do Medicare Advantage Members Leave Their Plans?

Although there are other reasons a policyholder may decide to discontinue their Medicare Advantage Plan, we will examine the three most common ones.

Hopefully, this information will assist you in locating the best Medicare plan for you or your loved ones.

Many people quit their Medical Advantage Plan because of the following reasons:

  • They are dissatisfied with the added advantages
  • A restricted network of physicians
  • Unreasonable cost allocation  

1. Dissatisfied by Medicare Advantage Plan Additional Advantages

Original Medicare does not cover a number of services for which you may wish coverage. Medicare excludes coverage for dental, vision, and hearing aids, as well as prescription medications.

Original Medicare may pay oral surgery if necessary or a pair of eyeglasses for cataracts, but preventative dental and vision services are never covered. Consequently, individuals opt for Medicare Advantage Plans.

Medicare Advantage plans are sometimes referred to as “all-inclusive” plans since they contain these additional benefits.

In spite of this, these services are a significant reason why individuals leave Medicare Advantage programs.

When enrolling in a Medicare Advantage Plan, you frequently give up the Original Medicare freedoms in return for the additional benefits. Once enrolled, many consumers discover that the extra benefits have extremely limited coverage and that it might be difficult to locate a doctor in their region that accepts the plan.

You may find yourself bearing the tab for care despite the fact that you believed your plan would cover the costs. Moreover, plans are subject to annual reviews. If anything, one year your plan may offer exceptional extra advantages, while the next year you may not have the opportunity to benefit altogether. 

2. Limited Medicare Advantage Networks

Another significant reason people abandon their Medicare Advantage Plans is network constraints.

With Medicare Advantage plans, the key to paying the lowest possible prices for health services is to stay inside your policy’s network.

Leaving your network may result in exorbitant prices or no coverage. Even with a Preferred Provider Organization plan, you will wind up paying extra to see out-of-network physicians.

In contrast, Medicare Supplement policyholders may see any Medicare-accepting physician. Therefore, many Medicare Advantage enrollees revert to Original Medicare in order to visit any doctor they choose. However, if you don’t mind doctor and hospital restrictions, a Medicare Advantage Plan may be suitable for you.

In this situation, it is crucial to remember that doctors might quit your plan’s network at any time. Thus, your physician may be in-network one month and out-of-network the following.

3. Inappropriate Cost-Sharing

Unreasonable cost sharing is another significant reason enrollees abandon their Medicare Advantage programs.

When enrolling in a Medicare Advantage plan, you must be mindful of your out-of-pocket expenditure maximums.

Medicare Advantage Plans often have substantially higher deductibles, copayments, and coinsurance than Original Medicare with a Medicare Supplement plan.

If you become unwell, your expenses might quickly accumulate. Despite the fact that your Medicare Advantage Plan may have a $0 premium, your expenditures may significantly surpass the premium savings.

The usual out-of-pocket limit for a Medicare Advantage plan ranges between $7,000 and $10,000.

What is Driving the High Rate of Medicare Advantage De-enrollment?

The Medicare Advantage Plans with the greatest de-enrollment rates are more likely to be for-profit (offered by private insurance firms), to have high out-of-pocket expenses, and to serve small geographic regions.

These plans also include a disproportionate percentage of subscribers with low incomes and disabilities.

Before choosing on a Medicare Advantage coverage, you must conduct comprehensive research to select the ideal plan. You must comprehend the deductibles, copayments, and benefits.

Additionally, consider the network and service area. If you travel frequently, a Medicare Advantage Plan may not be the best option for you. You may choose to compare Medicare Advantage vs. Medicare Supplement plans instead.

Final Thoughts

If you wish to modify your plan, you need contact a qualified agent. Ensure you are inside a valid enrollment period prior to making any changes.

Regardless of whether you choose Original Medicare, Original Medicare with Medigap, or a Medicare Advantage plan, you should conduct study beforehand.  

About the author 

Antony W is a professional writer and coach at Help for Assessment. He spends countless hours every day researching and writing great content filled with expert advice on how to write engaging essays, research papers, and assignments.

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