Why are people unhappy with Medicare Advantage plans?

Question

John L Herman Jr · Accepted Answer

I believe that most people who are unhappy with MEDICARE ADVANTAGE enrolled in the wrong Plan to begin with.  Too many people scratch around on the Internet and see a low price or answer the telephone and sign up with a harassing caller who puts them in a Plan without knowing all of the facts necessary to get the correct Plan.

Also...many Agents are only Licensed by certain Insurance Carriers so people end up i the wrong Plan.  A good Independent Broker would show clients the good and bad of all Plans letting the client make the correct choice for their situation.

Lt Col Tim Brown · Answer

I don’t think they are. My wife and I are on one and we’re very satisfied with it, not to mention the well over a thousand people I’ve written plans for. I think people have preconceived notions and for them that’s reality. Typically you have no premiums for them. Some plans pay down the part B premium Medicare charges, and you have co-pays when you use the plan. Contact me if you’d like to discuss.

Answered by Lt Col Tim Brown on March 31, 2025

Broker Licensed in TN, AL, CO & 10 other states

Answered by Lt Col Tim Brown Medicare Insurance Agent

Tony Capraro III · Answer

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

Clarence &quot;Mark&quot; Christiansen · Answer

Did you know that approximately 50% of the Medicare population has Medicare Advantage? Popularity for this type of coverage is surging. Still, Medicare Advantage is not for everyone and there aren't too many things that we're all happy about. I think it's a lack of understanding that causes displeasure with Medicare Advantage. As a Medicare Advantage member myself for the past 5 years and having sold these products for 18 years, I am 100% happy with Medicare Advantage considering the thousands of dollars I have saved by using Part C. So what's the problem with Medicare Advantage? Have you talked with your agent and gained a full understanding of Medicare Advantage and how it works? Medicare Advantage plans, many of which feature $ 0 (zero) monthly plan premiums, have deductibles, copays and coinsurance depending on the plan. All Medicare Advantage members are protected by an out of pocket maximum which varies depending on plan and service area. This is in exchange for higher premiums associated with traditional Medi-gap or Medicare supplement plans. It's important to take the time to learn about these products before making an enrollment decision.

Answered by Clarence "Mark" Christiansen on April 3, 2025

Agent Licensed in WI, AZ, CA & 16 other states

Answered by Clarence "Mark" Christiansen Medicare Insurance Agent

Laura Shipman · Answer

Speaking from experience people that I talk to are happy with Medicare Advantage plans. In some cases if they did not understand the details of the plans then they may be unhappy. However if they have an agent they can trust who explains the details and they can call with questions or assistance then most clients are happy with Medicare Advantage plans.

Answered by Laura Shipman on May 5, 2025

Agent Licensed in KS

Answered by Laura Shipman Medicare Insurance Agent

Andrew Bennett · Answer

I'd say there are two key reasons.  The first is the most common and that is people do not stay within the insurance companies network.  Anytime you go to a new doctor you need to confirm that the doctor has a greed to work with your insurance.  To do this you need to call your agent, log into your online portal, or call the number on the back of your card.  

What generally does not work is calling the doctor's office.  The problem is that all these insurance companies have multiple networks.  They have medicare networks, HMO's and PPO's.  They have large group networks, small business networks, they have multiple networks for individual and family plans, and other networks for Medicaid recipients. 

The person answering the phone at the doctors office generally knows what companies they work with, but not which specific networks.  You have to check the network.  That's what the most frequent complaints I get are about.

That being said there's a second type of complaint that is much more serious.  This is where the insurance company won't cover something your doctor says you need...or they drag along and don't get answers to the doctor in a timely fashion.  These are called "utilization reviews" or "prior approvals".  The insurance companies will often say they are doing this keeps cost down for everyone.  

Sometimes it seems more like they are trying to protect their profits.

I urge people to appeal if they get a decision they don't like, but it is really seldom that people do.  One of the good things the Affordable Care Act (ACA) did was to send these appeals to a third party organization.  The insurance companies have to abide by the decisions these third party organizations make.  Before the ACA the appeal went to the insurance company...that's like the fox guarding the hen house.

If you do not want to mess with networks or a company protecting it's profit at the expense of your health stick with traditional Medicare and a supplement.

Steven Bleicher · Answer

Due to stricter rules governing “Prior Authorization”, also known as Step Therapy, it is a delaying tactic used by Advantage plans to pay a cheaper price for a supposedly equivalent drug. The practice has gained popularity and causes consternation with doctors who are referring to the best prescription drug based on the malady you have.

Answered by Steven Bleicher on May 8, 2025

Broker Licensed in AZ

Answered by Steven Bleicher Medicare Insurance Agent

Timothy Brown · Answer

Listed are a few reasons that people may be unhappy with Medicare Advantage plans:

1) Reduction in benefits in comparison to previous years

2) Providers no longer accepting plans or now out of network

3) Delays in prior authorization for medically requested procedures

4) Denial of claims for specific procedures

5) Plans exiting the market

Ami Fouts · Answer

I'm not seeing this is my line of business. I have a lot of people really enjoy Medicare Advantage plans due to the extra benefits, and most Advantage plans don't cost any additional money.

Matt Vinez · Answer

I see very few people unhappy with Advantage plans, provided they made wise decisions enrolling. Using a local broker costs a client nothing, and can help insure they pick a plan that will work for their needs. The majority of horror stories you hear are people buying directly from a website or hotline, with no local assistance on network or formularies, and then getting stuck.

Answered by Matt Vinez on April 14, 2025

Broker Licensed in MN, FL, IA & OH, SD, TX & WI

Answered by Matt Vinez Medicare Insurance Agent

Doreen Dann RN, BSN, MHA · Answer

Not all people are unhappy with Medicare Advantage plans but if they are, usually it is because of the required authorization process or having to stay within a closed network if they chose a MAPD-HMO rather than a MAPD-PPO plan if available.

Answered by Doreen Dann RN, BSN, MHA on April 22, 2025

Agent Licensed in CA, AZ, CO & 9 other states

Answered by Doreen Dann RN, BSN, MHA Medicare Insurance Agent

Marcie Barnes · Answer

Choosing the right coverage is personal choice.  What might be good for one individual is not for another.  

It's all a matter of preference, budget and lifestyle.  

A licensed professional can insure an individual is getting the coverage that is best for them.

Robert Simm · Answer

I think the media plays it up a little bit more than what the true reality is. Do the insurance companies require pre-authorization from the providers on the services they provide that question is a hard yes. Traditionally the one plan that would get the most prior authorizations would be a plan on HMO coverage versus PPO. If a Medicare beneficiary is going to be utilizing a lot of medical services for the calendar year then it might be worth it to take a look at a PPO plan to see if they can remove some of the authorizations.

Answered by Robert Simm on April 7, 2025

Broker Licensed in NC, AL, AR & 15 other states

Answered by Robert Simm Medicare Insurance Agent

Kimberly Hargis · Answer

The Inflation Reduction Act’s changed what plans offered as far as extras. The OTC, food cards are a couple things affected by the IRA. The insurance companies lost a lot of funds due to the prescription max out of pocket going down to $2000 for the year. The Medicare Advantage plans are as good as ever as far as benefits.

Answered by Kimberly Hargis on May 17, 2025

Broker Licensed in TN, FL & KY

Answered by Kimberly Hargis Medicare Insurance Agent

David Cranford · Answer

Usually the problem comes from not getting precertified for testing or for an elective proceedure. There are steps to remedy this issue. Also the continual negotiation for reimbursement amounts may cause an interuption in service from a hospital or doctor's office. Generally, the better you understand the coveraqe from your Medicare Advantage plan the happier you are and the less confusion is experienced.

Answered by David Cranford on April 14, 2025

Agent Licensed in OK, FL, IL, OH, TN & TX

Answered by David Cranford Medicare Insurance Agent

Why are people unhappy with Medicare Advantage plans?

Agents: Share Your Expertise

Seniors: Ask a Question of Your Own

Related Questions

Agent Locator

Medicare Agents Hub
A non-government resource website

Why are people unhappy with Medicare Advantage plans?

Agents: Share Your Expertise

Seniors: Ask a Question of Your Own

Related Questions

Agent Locator

Medicare Agents HubA non-government resource website

Medicare Agents Hub
A non-government resource website