When you want to leave your Medicare Advantage Plan — but feel stuck
About half of Medicare Advantage members left their plans by the end of five years, according to a study published in 2023
About half of Medicare Advantage members left their plans by the end of five years, according to a 2023 study from Brown University School of Public Health. Most switched to another Medicare Advantage plan, but not necessarily because they liked Medicare Advantage. Returning to Original Medicare can be tricky after you first sign up, because you may not be able to get a Medicare Supplement Insurance plan, known as Medigap.
But for people with serious or chronic health conditions who have Medicare Advantage, limited provider networks and prior authorization requirements may make it difficult or expensive for them to get the care they need. It’s helpful to understand your options.
WHEN MEDICARE ADVANTAGE ISN’T THE RIGHT PLAN
Medicare Advantage plans typically require members to get health care from doctors and hospitals within a network. Members might have trouble if their doctor falls out of network or they want to see a specialist who doesn’t take their plan. Medicare Advantage plans also may require you to get approval before they cover some services or medications.
While most Medicare Advantage enrollees are in plans with a $0 premium, getting medical care costs money, and Medicare Advantage plans can have an annual out-of-pocket maximum as high as $8,850 in 2024.
Joanne Giardini-Russell, owner of the insurance agency Giardini Medicare in Michigan, recalls a client who had a Medicare Advantage plan and got cancer. “He was hitting his max out-of-pocket year after year,” she says. “And then throw in prior authorizations, which he wasn’t a fan of.”
WHEN YOU CAN CHANGE PLANS
If you have Medicare
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