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 are 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 agreed 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 doctor's 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, its profit at the expense of your health stick with traditional Medicare and a supplement.

Jennifer Whitworth · Answer

Medicare beneficiaries are often unhappy with Advantage plans for several reasons:

- High Out of Pocket Costs:  such as high deductibles, copayments and co   insurance.  This can be a hardship for individuals with chronic conditions or needing frequent office visits.

-Provider Network Restrictions:  Because of sometimes limited provider networks, beneficiaries may not be able to continue seeing the providers they have long standing relationships with and need to make changes sometimes in the middle of treatment plans.

-Prior Authorizations and the possibilities of Denials:  Often these plans have prior authorization requirements for certain testing and or treatments which could delay any existing treatments plans or that needs to begin.

-Plan Changes:  Some plans could make provider network, coverage and costs change annually.  Extra plan benefits are sometimes not as comprehensive as previously understood. 

-Inability to Switch Plans:  Beneficiaries find it difficult switching back to Original Medicare if they have developed chronic conditions or have aged and Medigap plans may not be guaranteed issue for them or have premiums that are not affordable.

- Aggressive Marketing:   Some plans are marketed aggressively with misleading information about costs and the benefits being offered.

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

Steve Houchens · Answer

In my experience anyone that has been unhappy with an advantage plan has been due to not having had benefits fully explained to or didn't understand potential out of pocket cost that could be involved. Generally it comes down to not understanding the coverage completely.

Answered by Steve Houchens on June 27, 2025

Agent Licensed in KY & TN

Answered by Steve Houchens Medicare Insurance Agent

Michael Pyers · Answer

Because at times it takes way to long to get approval for things like critical MRI's, etc.  Also, you may have claims that are not paid because you didn't use a Doctor in the plans network.

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.

Toni Cormier · Answer

Medicare Advantage plans are great for chronically ill members who are financially challenged; however, they benefits are limited to their networks, having to acquired prior authorizations which delay care and lower premiums but higher out-of-pocket cost.

Answered by Toni Cormier on July 12, 2025

Broker Licensed in TX, CA & OK

Answered by Toni Cormier Medicare Insurance Agent

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

Jim Carroll · Answer

It has been my experience that there are two reasons:

1. Even though most Medicare Advantage plans typically do not have a monthly premium, they do have other out-of-pocket expenses that people feel are either unwarranted or unfair. This is partly due to most seniors who have a Medicare Advantage plan are living on less income than when they were working. Therefore, the extra medical expenses are a pain point.

2. Medicare Advantage plans that are HMOs require members to get a referral from their Primary Care Physician to see a specialist. This additional step is perceived as a ridiculous waste of time and copay.

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?

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