They have realized that a Medigap plan aka, Med. Supplement does not have those “Prior Authorization” (PA) issues which will delay an immediate visit with a doctor. This means that your company wants to determine if a less expensive drug works just as well as the one originally written by your doctor. This process is also called “Step Therapy”. With the scarcity of doctors now in our society, it is rare if you are very sick to be able to see your Primary Care physician right away. So, that together with “PA” can be very frustrating when you don't feel well.
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.
I have historically set clients up with a fairly even mix of Medicare Advantage and Medicare Supplement Plans.
I'm finding that I am getting more phone calls lately from people who have had Medicare Supplement plans for many years and want to change to a Medicare Advantage plan.
I think if we, as brokers, educate clients properly then they are able to make a clear, well thought out decision on which direction they want to go with their Medicare coverage; traditional Medicare and a Medicare Supplement or a Medicare Advantage Plan. There are benefits to both and there is a right answer for each person.
If we, as brokers, educate our clients well and then allow them to select the coverage that fits their personal financial situation and their personal value system then we will see a fairly even split between Medicare Supplements and Medicare Advantage plans.
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.
People may leave a Medicare Advantage plan to go to another one during open enrollment.
Some people may try a Medicare Advantage plan and then decide to go back to a Medicare Supplement plan. As far as how many are on Medicare Advantage vs supplement, there are now more Medicare beneficiaries on Medicare Advantage than supplement plans across the US.
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.
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.
Many people leave Medicare Advantage plans because they don't like the restrictions regarding "in network" doctors. Many seniors also like the stability of knowing 100% what their out-of-pocket medical expenses will be. With the "Maximum Annual out of Pocket" in MA plans the out of pocket can actually be significantly more than with original Medicare and a supplement.
You may have heard of neighbors or friends leaving the Medicare Advantage Market however I can say I have more people on the Medicare Advantage Market than on Original Medicare with or without a Medigap Plan. If people are leaving, it may be for the freedom they have utilizing Original Medicare with a Medigap Plan of being able to go to any physician or provider that accepts Medicare anywhere in the United States. No network restrictions and with a few plans no co-pays.
Remember, if you are not in your initial election period you will have to go through underwriting when going with a Medigap plan to pair with Original Medicare.
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.
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.
