Why are seniors losing Medicare Advantage plans?

Question

Yasmery Vargas · Accepted Answer

Many things can factor in to the loss of a medicare advantage plan. Plan could move out of the service area or be discontinued, you could drop your Part b benefits with social security causing your medicare advantage plan to drop or the loss of medicaid status, depending on the plan, can cause your medicare advantage plan to drop. Anything that changes your eligibility for a plan can cause a medicare advantage plan to drop.

Answered by Yasmery Vargas on April 21, 2025

Agent Licensed in PA

Answered by Yasmery Vargas Medicare Insurance Agent

Ben Washington · Answer

Why are seniors losing Medicare Advantage plans? A company can choose no longer offer MA in area, or Non payment or they enrolled in a part D Plan will disenrolled from a MA or they travel away from plan area for over 6 months

Answered by Ben Washington on April 22, 2025

Broker Licensed in IL, FL, MN, SC, TX & WI

Answered by Ben Washington Medicare Insurance Agent

Thomas Ashton · Answer

Seniors that are not paying for the plan if there is an additional cost is one reason they could lose their Medicare Advantage Plan. Also, if the carrier cannot sustain enough business in a county, the carrier can drop out of the area.

Answered by Thomas Ashton on April 7, 2025

Broker Licensed in FL, AL, AZ & 6 other states

Answered by Thomas Ashton Medicare Insurance Agent

Ali Crouch · Answer

Some companies offer very high extra benefits and lose money. CMS is also changing what advantage plans can allow in their plans, making competition harder.

John Budde · Answer

In some cases, Seniors are losing Medicare Advantage coverage due to a combination of factors, including insurers withdrawing from unprofitable markets, rising costs, and changes in reimbursement rates under the Inflation Reduction Act. These changes are forcing insurers to make tough decisions about which plans to keep, potentially leaving many seniors without their current coverage options.

Answered by John Budde on May 29, 2025

Broker Licensed in IA, NE & SD

Answered by John Budde Medicare Insurance Agent

Steven Bleicher · Answer

The more correct question is why are seniors voluntarily dropping their MA plans? You can’t “lose” a plan but it can be cancelled by the member. The main reason for this is “Prior Authorization”. Recently, I saw a question about why a Medicare member was sent an invoice for his knee replacement surgery? Naturally, this is among the 60,000+ approved procedures that will be paid for. But since the economy is not expected to do well over the next few years, each insurance firm wants a look into the member’s records and assess whether the surgery is warranted? It’s somewhat analogous when you require dental surgery. As long as you’re not in pain and can wait, you would rather budget for it when it is a better option financially. Lastly, since the Advantage plan is subsidized by the government which has been quite erratic of late, people feel more comfortable with a private insurance company by buying a Medicare Supplement (Medigap) plan.

Answered by Steven Bleicher on June 14, 2025

Broker Licensed in AZ

Answered by Steven Bleicher Medicare Insurance Agent

Diana Garner · Answer

The main reason is financial pressure. The Inflation Reduction Act (IRA) reduced reimbursement payments to Medicare Advantage plan insurers and capped prescription drug costs.

It is harder for insurers to offer the same benefits and coverage while reimbursements are being cut. Many insurers are reducing the number of plans they offer or pulling out of the market altogether.

Fred Manas · Answer

Seniors are losing Medicare Advantage coverage due to several factors, including insurers exiting markets, rising costs, and changes in Medicare reimbursement rates. The Inflation Reduction Act (IRA) has also played a role by introducing prescription drug caps and reducing base payments to Medicare Advantage insurers, further pressuring insurers financially. 
Here's a more detailed breakdown:
Insurers exiting markets:
Many insurers are pulling out of specific markets or reducing their plan offerings, which directly impacts seniors who previously had those plans. This can be due to factors like rising costs, changes in reimbursement rates, or simply being unable to continue operating profitably in certain areas. 
Rising costs:
Medicare Advantage plans are experiencing increased costs, including those related to higher utilization of care and changes in prescription drug costs due to the IRA. 
Changes in Medicare reimbursement rates:
The IRA has introduced changes to how Medicare Advantage plans are reimbursed, which can impact their financial viability and lead to plan closures or reductions in benefits. 
Prior authorization and payment issues:
Many health systems have cited excessive prior authorization denial rates and slow payments from insurers as reasons for dropping Medicare Advantage plans, further impacting seniors. 
Prescription drug costs:
The IRA's prescription drug caps and rising copays have also contributed to the increased costs faced by seniors and insurers, potentially leading to more plan changes or closures. 
"Trapped" seniors:
Some seniors feel "trapped" in Medicare Advantage plans due to their complex structures, narrow networks, and limited options when facing serious medical needs. This can lead to frustration and a desire to switch to traditional Medicare.

Carol Thompson · Answer

Often times seniors can be dropped by a plan because of a change of income - lifestyle change or no longer live in the service area. 

If you are on a chronic special needs plan - you need to be sure your primary dr signs off that you have that chronic condition - verification chronic condition form. As an agent I verify with the carrier prior to the deadline for my clients.

Toni Chavez · Answer

Hello,

I’m not sure I understand your question.

If you’ve lost your MAPD plan it may be the carrier is no longer offering that plan in your area.  We did see a lot of this for 2025
Plan year. 

I always suggest looking out for your Annual Notice of change (AOC) to keep informed of your specific plan changes.  

If you have a broker we normally notify our clients when these things are going to occur way ahead of time.

Glenn Alterman · Answer

They are getting plans with benefits they actually use and many plans are dropped due to possibly lower enrollments

Wild Bill Anderson · Answer

The last administration cut funding to Advantage plan.  But just recently the reimbursement has increased.
But the cost to reduce drug maximum out of pocket comes at a huge cost.. Some plans would have been losers so better to reduce the number of plans so they can be viable long term.

Rodolfo Rojas · Answer

The Medicare Advantages are going forward. The plans are for a year, so every year you have to choose to stay in your plan or choose another. Every year there are new plans in Medicare Advantages. The people who have Medicaid and Medicare may not qualify for a plan due to the incorporation of Medicare moving to care management, which means they would have to choose a new plan.

Answered by Rodolfo Rojas on June 8, 2025

Broker Licensed in NV, AL, AR & 22 other states

Answered by Rodolfo Rojas Medicare Insurance Agent

Betty McCarty · Answer

Many insurers are adjusting their Medicare Advantage offerings due to financial and regulatory challenges, which may affect availability in certain areas. 

While this can feel unsettling, know that you don’t have to navigate the Medicare landscape  alone—support and alternative coverage options are available to help you stay protected and informed. 

If you have further questions or concerns please feel free to reach out to your local Medicare agent, or email us at bkconnections@comcast.net.

Natalee Nimmo · Answer

Because many plans are deciding to not offer Medicare Advantage plans in some areas. Therefore they are no longer offering plans in those areas.

Mike Sosso · Answer

Some seniors are losing thier Medicare Advantage plans because many of these plans are leaving areas or no longer being accepted by some healthcare providers. As a result if the plan decides to either leave an area or is no longer accepted by providers in that area, seniors can lose that coverage. When that happens however, they are usually allowed to enroll in another advantage plan or revert back to Original Medicare

Answered by Mike Sosso on May 13, 2025

Broker Licensed in TX, AZ, NC & SD

Answered by Mike Sosso Medicare Insurance Agent

Britania James · Answer

Plans change each year. Sometimes, certain plans are no longer available in particular counties or states, and this could cause a member to lose coverage.

Angel Feliciano · Answer

Seniors may be losing Medicare Advantage plans for several reasons:

1. **Plan Changes**: Insurance companies may change their offerings, leading to discontinuation of certain plans in specific areas. This can force seniors to find new coverage.

2. **Network Changes**: Some Medicare Advantage plans may alter their provider networks, which can result in seniors losing access to their preferred doctors or hospitals.

3. **Cost Increases**: Premiums, deductibles, or out-of-pocket costs may rise, making the plans less affordable for some seniors, prompting them to switch to other options.

4. **Health Needs**: As health conditions change, seniors may find that their current Medicare Advantage plan no longer meets their needs, leading them to seek different coverage.

5. **Enrollment Limitations**: Seniors may miss enrollment periods or be unaware of their options, resulting in a loss of coverage when their current plan is no longer available.

6. **Regulatory Changes**: Changes in Medicare regulations or policies can also impact the availability or structure of Advantage plans, affecting seniors' access to these options.

Ultimately, it’s important for seniors to stay informed about their Medicare options and any changes to their plans to ensure they maintain appropriate healthcare coverage.

Why are seniors losing Medicare Advantage plans?

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Why are seniors losing 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