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People may leave their Medicare Advantage plans for a variety of reasons

Why Do People Leave Medicare Advantage Plans?

Private insurance companies offer Medicare Advantage plans (Part C). They provide members with an array of benefits that Original Medicare doesn’t offer. Despite the advantages, beneficiaries might leave their plan for various reasons. The program may not be as inclusive as they thought. 

Why Choose Medicare Advantage?

An Advantage plan could be beneficial for people under 65 or those who can’t afford Medicare Supplement insurance. Medicare varies by state, so you should compare your options. 

Related Post: How to Choose the Best Medicare Advantage Plan

Why Leave Medicare Advantage?

Unsatisfied with the Dental Benefits

Advantage plans are often considered all-in-one plans. Some include vision and dental coverage, which Original Medicare doesn’t cover. However, your policy might only cover preventative services. Limits like these could have you bear the cost for dental care — besides the exam and cleaning. Plus, Medicare Advantage plans change every year.     

For instance, you may join a program because of dental coverage. Then, that same program could drop the dental benefits next year. Since you’ll probably pay for root canals and other dental care, you may consider buying a stand-alone dental policy. Either way, when shopping for dental insurance, remember to double-check the benefits.   

Limited Network of Providers

Another common reason why people leave their Medicare Advantage plan is due to network restrictions. Going out of the network for care could result in high fees. Even if you have a Preferred Provider Organization (PPO) plan, you’ll pay more to visit doctors that aren’t in the network.  

Some people aren’t bothered by the doctor and hospital limitations. But if this irritates you, consider a Medicare Supplement plan instead, which lets you see any doctor that accepts Medicare. 

With Medicare Advantage, the doctors may leave the network at any point, and plans change annually. So, a program may offer complete coverage for one year but be ill-suited the next. 

High Cost-Sharing

Beneficiaries may also leave their Advantage plan because of high cost-sharing. By joining a Part C plan, you agree to pay copays and coinsurance down the road. 

Although you could have a $0 premium with your plan, your costs could significantly exceed that. For example, you could have a $20 copay for a doctor checkup. But your doctor may send you to a specialist, who charges a $50 copay. Then, that specialist could order a procedure that requires a larger copay or coinsurance. It’s crucial to read the particulars. Your plan’s summary of benefits should help you understand the kinds of copays you’ll have.    

X-rays could be $100, an ambulance could be $300, and a hospital stay could cost $250 per day for your first six days. So, your costs can add up — fast. If you were to develop a severe illness, these prices could soar, depending on the services you need.    

Other Reasons for Leaving Advantage Plans

  • The person finds a cheaper policy.
  • Some have strict rules you must follow to get coverage.
  • It can be challenging to get health care while you’re traveling.
  • It can also be hard to get emergency care. 
  • Plans that include Part D coverage may limit certain expensive prescriptions.

Related Post: Medicare Advantage Benefits – Why a Gym Membership Is Important

Want to Leave Your Medicare Advantage Plan?

If you’re looking to change your plan, we suggest using a Medicare agent. When you work with Trusted Senior Specialists, you get one-on-one expert help at no additional cost. Not only do we help you choose a policy, but we’ll also make sure you understand your plan’s benefits, network restrictions, and cost-sharing — to avoid potential issues. Call (855) 952-1941 or contact us online!