Why are people leaving Medicare Advantage Plans? In this video, we’re going to talk about that, so please stay tuned. My name is Jamie from MeetJamie.com. I’m an independent insurance broker. I help people all over the country understand how the Medicare program works as well as I help them find the coverage that fits their needs.
The Appeal of Medicare Advantage
In today’s video, I want to talk about why are people leaving Medicare Advantage plans.
So those of you who may not be familiar with Medicare Advantage, Medicare Advantage is another way to receive your Medicare benefits. As far as the parts of Medicare go, it’s known as Part C of Medicare, and it’s very appealing to many people because of the additional benefits that it provides that Original Medicare doesn’t. Things like vision coverage, dental coverage, hearing coverage, gym membership. Some of them even give you meals, and there are flex cards and all kinds of things now. So they’re marketed very heavily, especially in the fall around the Annual Enrollment Period for Medicare. And there are many people who signed up for a Medicare Advantage plan, and so you may be wondering or maybe researching and saying, “Well, it sounds really good, why would people leave?” So we’re going to talk about that today.
The Disadvantages of Medicare Advantage Plans
So one of the primary reasons leading to people leaving Medicare Advantage is the limited networks that they have to stay in. So when you have a Medicare Advantage plan, usually it’s an HMO or a PPO, and you have to agree to stay within that plan’s network of providers. So this would include your doctor, any specialist that you go to, clinic, hospital, those types of things. So if you sign up for a Medicare Advantage, please make sure that the agent that you work with is double-checking that your providers are all in the network, because there’s nothing worse than signing up for a plan, going to your doctor’s office and having them tell you, “we don’t take this plan.”
Medicare Advantage Network Restrictions
Why are people leaving Medicare Advantage plans Network restrictions are one of the big reasons why people leave a Medicare Advantage plan. If you have Original Medicare, which is your A and B, you can go anywhere in the country that accepts Medicare, and that is a very, very large network, as you can imagine. So I would say the number one reason that people leave Medicare Advantage plans or want to leave a Medicare Advantage is because of the limit in the network.
Medicare Advantage Annual Changes
Another big reason is the changes that happen every year. So if you have a Medicare Advantage plan, every year the provider has to send you the details of the changes within your plan for the coming year, and there are always changes, whether it’s how much a service is covered, how a drug is covered, even the provider, again, going back to the network, if the network changes.
Every year as an agent, I see news stories all the time about providers who stop accepting Medicare Advantage plans. So one of the big reasons is that there are changes every year, and so every year it’s important if you have a Medicare Advantage plan, look for that letter in the mail. It usually comes in early fall, or late summer. You want to read over that, understand, okay, what changes are happening with my Medicare Advantage plan?
Medicare Advantage Out of Pocket Costs
Another big reason is that a lot of people signed up for a very low monthly premium Advantage plan, so let’s say you do what’s called a $0 Medicare Advantage plan, the low premium of zero is very appealing to you, but the problem is, or the challenge is that there’s out-of-pocket expenses and there’s a maximum out-of-pocket that each Medicare Advantage plan has for the whole year. And depending on which Medicare Advantage plan you choose, it could be several thousand dollars. So yes, you may pay little to no premium, but you would have other costs like co-payments, and co-insurance deductibles. So if you’re watching this video and you have a plan, or if you have an experience with Medicare Advantage, I would love to hear from you in the comments below.
Medicare Advantage Limited Providers
The other reason, a big reason why people leave Medicare Advantage plans, is depending on where you live, the limited geographic coverage. So typically when I talk with people, I want to understand where they live, because if you are in a larger metro area, a large city, then there are a lot more providers and the Medicare Advantage plans companies, compete very heavily for your business, so it’s beneficial to you. If you start getting into more rural areas, then you can start having a challenge of where you can go and where you can be seen, and it requires a little more due diligence to find providers that will take your plan.
Medicare Advantage Prior Authorizations
Another big reason is the complexity of the rules, regulations, and prior authorizations of the requirements of each plan. So there’s nothing more frustrating than having to go to the doctor, go to the clinic, go to the hospital, you’re dealing with an illness or a sickness, and then have to have a conversation with your insurance company about what was provided and what wasn’t provided and why it was provided or why it wasn’t provided. So that’s another thing to consider.
And then the last reason I’ll say is that a lot of people just plain didn’t know what they got when they signed up the first time. Someone called them on a phone, this is why you should be very careful when people call you about Medicare or Social Security or anything like that because I’ve talked to people, who said, “Someone called me and they said I needed to change my plan, and I did.” They didn’t even know what they got. And they did some research, they educated themselves and they realized, “Oh, I signed up for this plan, that’s not what I wanted. I wanted a Medicare supplement plan that would go along with Original Medicare. I didn’t even know that was an option.” I’ve had people tell me that. And so people do some research, they figure it out and they say, “I’d like to go back on original Medicare and get a supplement if I can?”
How to Switch Back to Original Medicare
The one thing to always keep in mind is that if you’re outside your Open Enrollment for a Medicare Supplement plan and you want to go back on Original Medicare and get a supplement, you’re most likely going to have to go through medical underwriting. There are a few exceptions to that, but most likely you’re going to have to go through medical underwriting to qualify for that Medicare supplement plan. So it’s not just a matter of, I’ve had this Advantage plan for a while now, I wanted to go over to a Medicare Supplement. You want to keep that in mind. So if you do have some health issues, whoever you talk to, whatever agent or broker you talk to, you want to tell them that and they’ll be able to tell you in fairly short order whether or not they think you’re a good candidate to apply for a supplement going through the medical underwriting.
Again, this is just a video about why are people leaving Medicare Advantage plans. I always want people who watch my channel to do their own research. I want to help educate them to the best of my ability, because as a beneficiary, being educated is the most important thing. When people come to me initially, they say, “What’s the best plan? What’s the best company?” And I always want to slow down the conversation and say, “Do you understand how the program works?” so that you know what you’re getting when you sign up for a plan.
That’s all for today’s video, I hope you enjoyed it. If you did, be sure to subscribe to my channel, hit the like button. If you have questions about Medicare, feel free to leave a comment below. If you’d like to chat with me on the phone, I’ll leave my contact information in the description of this video as well. So, thanks for watching. Have a great day.
If you have questions about Medicare, feel free to give me a call at 1-800-974-0552.