Why Do People Leave Medicare Advantage Plans?

The choice to leave a Medicare Advantage plan can be triggered by various factors, including dissatisfaction with coverage, high out-of-pocket costs, changes in health status, or plans that no longer suit the individual’s needs.

Regardless of the reason, beneficiaries need to be aware of their options when leaving a Medicare Advantage plan.

Why Leave an Advantage Plan?

Listed below are the primary reasons:

  • Limited networks: Networks can differ in size and composition across plans. Depending on the chosen plan, enrollees may have access to a smaller pool of in-network providers and limited access to specialists like oncologists or neurologists.
  • High costs: Medicare Advantage plans provide affordable coverage, but seniors may still have high out-of-pocket expenses such as copays and deductibles.
  • Changes in prescription drug coverage: Medicare Advantage plans offer limited Part D drug coverage, and some medications may not be covered. Seniors may have to switch plans or pay out-of-pocket.
  • Quality of care: Seniors on Medicare Advantage plans expect quality healthcare services, but sometimes the care provided falls short due to issues like long wait times, limited hours, or staff shortages. Seniors may also need to travel further to reach a network healthcare provider.
  • Lack of flexibility: Medicare Advantage plans may be constrictive and restrict access to care, which can be frustrating for seniors who want more control over their healthcare choices.

When Can I Unenroll?

Unenrolling from a Medicare Advantage plan is subject to specific periods.

The Annual Election Period (AEP), or Open Enrollment, occurs from October 15 to December 7. During this time, you can modify your Medicare coverage, which includes the option to discontinue your Medicare Advantage plan and revert to Original Medicare or switch to a different Medicare Advantage plan.

The Medicare Advantage Open Enrollment Period extends from January 1 to March 31, allowing you to switch from your current Medicare Advantage plan to an alternative plan or return to Original Medicare.

Additionally, Special Enrollment Periods (SEPs) may grant you the opportunity to unenroll if circumstances arise, such as relocating outside your plan’s service area, losing your existing coverage, or if your plan alters its contract with Medicare.

Bottom Line

Leaving a Medicare Advantage plan can benefit Medicare beneficiaries who are unhappy with their current coverage or find that the plan no longer meets their needs. It is important to carefully consider the advantages and disadvantages of each plan, as well as the timing for unenrollment, to make an informed decision.

We recommend you speak with a qualified agent who can guide and advise on your current situation’s best course of action. With their help, seniors can make an informed and confident decision.

Sources: NPRMedicareRightsKFF


What alternatives are there to Advantage plans?

Seniors can return to Original Medicare, which consists of Part A (hospital) and Part B (medical) insurance. They can also enroll in a Medigap policy to provide additional coverage for services not covered by Original Medicare.

Why might someone unenroll from a Medicare Advantage plan?

Disenrollment might be due to several factors, such as dissatisfaction with coverage, high out-of-pocket costs, changes in health status, or finding that the plan no longer meets their needs.

Mark Prip

For more than two decades, Mark Prip at My Medigap Plans has been an authority figure in the insurance industry and continues to uphold a mission to provide customers with comprehensive information about Medicare, life, and dental coverage. In addition, his expertise is unmatched - having helped thousands of Medicare beneficiaries choose suitable healthcare plans for themselves - making him stand out above competitors.