Why are people leaving Medicare Advantage plans?

Question

Tony Capraro III · Accepted Answer

This answer is provided in a video format. Watch the agent's video response here: https://medicareagentshub.com/questions/why-are-people-leaving-medicare-advantage-plans#tony-capraro

Tammie Rutledge · Answer

As a Broker, I am not finding that to be true. I would say that my business is 85 % Medicare Advantage and 15% Medicare Supplements. Medicare Supplements are appropriate for some, but most people don't go to the doctor enough to justify that monthly expense.

Answered by Tammie Rutledge on April 9, 2025

Broker Licensed in WA, AZ, FL & ID, MT, OR & TX

Answered by Tammie Rutledge Medicare Insurance Agent

Steve Brauer · Answer

If you live in a rural area,. or an area that does not have a good Medicare Advantage plan "network", people can be disappointed in the amount of providers available to them. Sometimes people have been denied services from Advantage plans because the plan deemed the service not to be medically necessary.

Answered by Steve Brauer on April 14, 2025

Broker Licensed in AZ & CA

Answered by Steve Brauer Medicare Insurance Agent

Mel Stevens · Answer

In my opinion, there aren't a lot of people leaving Medicare advantage plans. In fact, I see the opposite as many people are switching from Medicare supplement plans to Medicare Advantage. Medicare Supplement are good but in general they do cost more money out of pocket because there is a monthly premium that needs to be paid. In addition, if a Medicare recipient would need to pay additional money out of their pocket if they needed benefits such as dental, vision and hearing. Medicare Advantage plans have additional benefits included where Medicare Supplement plans may offer discounts but do not have full ancillary benefits available. Those costs can start to add up quickly in this current day and age where inflation is taking a toll on all of us. In addition, Medicare supplement premiums will increase from year to year as well. Be aware, if you decide to switch form a Medicare supplement plan to a Medicare Advanta age and decided that you want to switch back, medical underwriting will be required. If you develop major health issues, then you may not qualify.

Answered by Mel Stevens on April 6, 2025

Broker Licensed in AZ

Answered by Mel Stevens Medicare Insurance Agent

Casey Peterson · Answer

First, in most areas, we are not seeing people leave Medicare Advantage plans in any great numbers. In my experience, if people leave a Medicare Advantage plan it can be for a few reasons. Some people have a doctor or facility they want to see and that provider is not contracted with their Medicare Advantage plan. Some people travel most of the year and want the freedom to see any Medicare provider in the country without a referral required. On occasion, someone are given bad information on how their plan works and leaves a Medicare Advantage because of that bad info. Most times it is an education issue, not a plan issue. However, there are times when a Medicare Advantage plan is not the best fit, and moving to Original Medicare and a stand-alone Prescription drug plan and a stand-alone Denta, Vision, and Hearing plan is a good option.

Answered by Casey Peterson on April 9, 2025

Broker Licensed in ID, AZ, CO & 6 other states

Answered by Casey Peterson Medicare Insurance Agent

Dominic Javier · Answer

Because Medicare (Advantage and Supplement) involves  complicated rules and procedures, lest updates and revisions from time to time, most beneficiaries get confused, eventually frustrated. You will need to understand Medicare/Medigap benefits, coinsurance, deductibles, copayment, hospital benefits, blood pints, hospice, skilled nursing care, etc. 

You will need a licensed, AHIP certified person who knowledgeable and experienced to guide you through the rules and procedures that will clearly give you practical options and solutions.

Diana Pedersen · Answer

1.Network Restrictions: MA plans can have limited provider networks
2.Prior Authorization Delays and Denials: MA plans frequently require prior authorization for treatments, which can delay or deny care.
3.Plan Terminations and Market Exits
4.Difficulty Switching Back to Original Medicare:

Michael Braun · Answer

In my experience when someone leaves a Medicare advantage plan, it could do to network issues or pricing of a product. Someone also might move out of the county they currently reside in so the plan is not available in that market or county. Consumers also might want to try something different or have a physical problem so a change is necessary.

Answered by Michael Braun on April 9, 2025

Agent Licensed in PA, FL, MD, NJ & SC

Answered by Michael Braun Medicare Insurance Agent

Why are people leaving Medicare Advantage plans?

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