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

William Lawler · Answer

First of all, this is NOT TRUE! People enrolling in Advantage plans are increasing daily. Advantage plans have copays and co-insurance, but there is an annual cap. Bill 636-675-7958

Tasha Riggs · Answer

They aren't.  This is misinformation.  Per Law Medicare Advantage plans have to cover the exact same things as Medicare. They cant be different.
How it is Covered is different from plan to plan.  Medicare Advantages have Extra Benefits like dental, vision, Hearing, and Over the Counter Items. 
They can work out of state, out of network and out of country.  Most plans do Not require a referral.   Plans very from State to State so contact a local broker who can really educate you.

Paul Potter · Answer

In Florida, nearly sixty percent of the people newly eligible for medicare have medicare.Advantage plans.  Most stay on Medicare Advantage.

Jason Hark, CMIS™ · Answer

Most of our clients do not leave the Advantage Plans, For those that do, they leave because they can’t always see the doctors they want and may have to get approval for care. The plans can also change every year, and sometimes cost more than expected.

Answered by Jason Hark, CMIS™ on June 4, 2025

Broker Licensed in IL, AL, AR & 16 other states

Answered by Jason Hark, CMIS™ Medicare Insurance Agent

Sandy Johnson · Answer

That is a matter of personal preference as it pertains several factors.  Those factors vary by individual.

Steven Bleicher · Answer

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.

Answered by Steven Bleicher on May 20, 2025

Broker Licensed in AZ

Answered by Steven Bleicher Medicare Insurance Agent

Cindy Clonts · Answer

I think some people may not understand all of the costs that you pay when you receive services. Most of the plans cost $0 or a little on the front end but it is pay as you go with a maximum limit. Some people don't like that. They just want to pay up front and not worry about costs when they go to the doctor.

Answered by Cindy Clonts on June 18, 2025

Agent Licensed in GA, AL, CA & 9 other states

Answered by Cindy Clonts Medicare Insurance Agent

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

Katheryn Evans · Answer

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.

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

Toni Chavez · Answer

Thanks for your question!   I’m not seeing clients leave medicare advantage plans,  I am moving people from Medicare Supps to Medicare Advantage plans for the financial savings benefit as well as the value added benefits of OTC, Dental, Vision and hearing.

In Arizona 85% of the market is on medicare advantage plans.  In my professional opinion MAPD make sense all the way around.

The advantage for my clients having me as their no cost broker I can review plan options every year and recommend based on their needs and benefits to maximize all offerings.

Hope this answers your question!

Toni Chavez

Deborah Webster · Answer

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.

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

Andy Kelly · Answer

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.

Answered by Andy Kelly on April 27, 2025

Agent Licensed in WA & OR

Answered by Andy Kelly Medicare Insurance Agent

Alexander Lehn · Answer

There are many reason why someone may choose to leave an advantage plan. The majority of people on Medicare are still on Advantage plans so it isn't necessarily a big exodus, but many people are concerned with the cuts happening to supplemental benefits or the potential for having a health claim denied. They may choose to go to original Medicare if they want to shoulder the 20% cost share or they may choose to get a supplemental plan (commonly referred to as Medigap plans) to help with what Medicare A & B do not cover. This decision should carefully analyzed based on health, income, and lifestyle. A competent Broker can guide individuals through the thought process to determine which route is best.

Answered by Alexander Lehn on June 6, 2025

Agent Licensed in NV, CA, FL & TX

Answered by Alexander Lehn 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:

Toni Johnson · Answer

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.

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

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

Demetrus Morton · Answer

Greetings, 

I think some people are leaving because their doctors and hospitals are not in network because of the new restriction and the difficulties . Also, the cost of some medicines make play a factor and having to get pre-authorization.

Thank you for your question, Please don't hesitate to contact me if you have anymore questions.

Best Regards
Dee

Why are people leaving Medicare Advantage plans?

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