Medicare Advantage plans are popular options for receiving benefits associated with Original Medicare. They’re convenient all-in-one plans with low premiums and lots of extras. However, many Medicare beneficiaries are leaving Medicare Advantage plans. Below we’ll discuss some of the reasons that this occurs.

Why are people leaving Medicare Advantage plans?

For some beneficiaries, a Medicare Advantage plan is the proper coverage. Still, others find these plans could be better for them. Unfortunately, there is a lot of misleading information surrounding Medicare Advantage and many commercials and marketing. Next, we’ll cover the biggest reasons beneficiaries leave the Medicare Part C program.

These Additional Benefits Can Be Frustrating to Use

One of the biggest enticements of a Medicare Advantage plan is the extra benefits that Original Medicare doesn’tdoesn’t cover. While many of these plans provide significant benefits, ease of access is very important to individuals on Medicare. Many of these benefits have very limited networks, and it’s difficult to find providers to provide them.

In addition, when talking about these benefits, the preferred dentist or eye doctor may not even come up. This results in coverage that the beneficiary may not use since they only want to use their dentist. While some plans provide excellent dental, vision, and hearing coverage, many only cover preventative services. This is one once of the leading causes of individuals leaving Medicare Advantage plans.

Restrictive Networks

When a beneficiary enrolls in a Medicare Advantage plan, they choose to enroll in insurance plans that are network based. For HMO enrollees, the coverage only works when providers are in the plan’splan’s network. The only coverage they can receive out of the network is in the case of an emergency. And while this seems acceptable, if you’re out of your service area, it’s possible that once the emergency has been stabilized, you’ll need to follow up with specialists before you can travel home. These follow-up appointments won’t be covered.

You’ll pay a significantly higher cost-share if you’re enrolled in a Medicare Advantage with out-of-network coverage. MA plans that allow for out-of-network coverage are Preferred Provider Organizations (PPO), Private Fee For Service (PFFS), and HMO-POS Medicare plans. It’sIt’s also possible that you’ll be required to pay the total amount out of pocket and submit the bill to your plan for reimbursement. Using in-network providers will help keep costs down.

Cumbersome Authorizations

Another major concern that’s contributing to the leaving Medicare Advantage is the authorization process for covered services. When enrolled in a Medicare Advantage plan, a referral will be necessary on most plans to see specialists. In many cases, this isn’tisn’t a big deal. However, they can be delayed or denied. If this occurs, you may have to redo the referral, be referred to another provider, or have a delay in your healthcare.

Referrals aren’t the only authorizations that are required. Medicare Advantage plans use a non-medical plan administrator to evaluate authorizations for procedures to treat medical conditions. There may be times when the treatment your healthcare provider recommends is denied. You must receive an alternative, less expensive procedure before the more expensive treatment is approved.

Are most people happy with Medicare Advantage?

Many beneficiaries are very happy with their Medicare Advantage plan. There are several reasons why some beneficiaries enjoy their Medicare Advantage health insurance. We’llWe’ll go over some reasons why some individuals enjoy their Medicare Advantage memberships.

Low Premiums and Predictable Cost-Sharing

Most Medicare Advantage benefits have an outlined fixed copay for most services. This makes it easy to predict how much a procedure will cost. In addition, to these fixed copayments, many Medicare Advantage health plans have little to no monthly premium.

Now some services will have a 20% coinsurance on most plans. Services such as durable medical equipment covered Part B drugs and chemotherapy will almost always require a 20% coinsurance. These out-of-pocket costs will all count towards the maximum out-of-pocket.

Additional Plan Benefits

One of the most used parts of a Medicare Advantage plan is the plan extras that aren’t included with the traditional Medicare program. These benefits can include gym memberships, Part B premium reduction, flex cards, over-the-counter allowances, and dental, vision, and hearing coverage.

All benefits aren’t on all plans, and specific special needs plans such as a Dual-SNP will expand the benefits in addition to Medicare and Medicaid. Another major plus is that an additional Part D prescription drug plan isn’tisn’t needed to cover prescription drugs. You can have integrated prescription drug coverage included in most Medicare Advantage plans.

Why do people dislike Medicare Advantage plans?

Most individuals that dislike a Medicare Advantage plan usually have had a bad experience with in-network providers, plan authorizations for medical care, or having to wait a long time to have an appointment scheduled.

Some of these concerns can be attributed to the healthcare provider. However, sometimes, the terms and conditions of the plan can be the culprit. Most of the reasons given by beneficiaries that dislike MA plans revolve around the reasons above.

Some also loathe the fact that if their doctor drops the plan, they can’t disenroll and start a new program. To make plan changes, a valid enrollment period is required.

FAQs

Who is trying to cut Medicare Advantage?

Unfortunately, many politicians strive to cut Medicare Advantage plans as part of the build-back better plan. They aim to lessen the effectiveness of Medicare Advantage plans to push people into a less efficient and more expensive single-payer healthcare system. Studies have shown that single-payer plans increase overall healthcare costs.

Why is Medicare Advantage controversial?

This form of Medicare coverage is controversial because a private company takes over your Original Medicare benefits. While this is true, these plans are required to cover the same items and services are Medicare Part A and Medicare Part B. In addition, they are required to provide, at a minimum, the same level of coverage and contain a maximum out-of-pocket limit to protect plan members.

Is Original Medicare better than Medicare Advantage?

Both coverages cover the same benefits. However, Medicare Advantage plans allow additional coverage and protections. They do limit your providers and required authorizations. Original Medicare has fewer restrictions and limitations, but there is no cap on what you can spend. Everyone’s needs differ, making it difficult to say if one is better. However, most beneficiaries don’t remain solely on Original Medicare.

Why do doctors not accept Medicare Advantage plans?

When a healthcare provider doesn’tdoesn’t accept a Medicare Advantage plan, it generally revolves around several reasons. First, they may want to charge more than the MA plan is willing to pay. Secondly, they may want to avoid applying for authorizations for treatments and referrals.

What’s an alternative to a Medicare Advantage plan?

Medigap plans are another route that can be taken instead of a Medicare Advantage program. These plans combine with Original Medicare to cover your out-of-pocket costs, such as the Medicare deductibles, coinsurance, copayments, and excess charges. These Medigap policies will allow you the freedoms of Original Medicare, such as using any provider nationwide that work with Medicare and fewer restrictions.

Get Help Finding a Medicare Plan That Fits Your Needs

Whether you’d like a Medicare Advantage plan or alternative options such as a Medicare Supplement insurance or even just a Part D plan, we can help. Our licensed agents can help you determine which supplemental plan will fit your needs.

Fill out our online request form or give us a call. We can answer all your supplement insurance questions and make the process easy to understand.

 

 

Written By:
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Lindsay Malzone, Lindsay Malzone is the Medicare editor for Medigap.com. She's been contributing to many well-known publications since 2017. Her passion is educating Medicare beneficiaries on all their supplemental Medicare options so they can make an informed decision on their healthcare coverage.
Reviewed By:
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Rodolfo Marrero, Rodolfo Marrero is one of the co-founders at Medigap.com. He has been helping consumers find the right coverage since the site was founded in 2013. Rodolfo is a licensed insurance agent that works hand-in-hand with the team to ensure the accuracy of the content.