Why Are People Leaving Medicare Advantage Plans

Medicare Parts A and B Enrollment Periods

When it comes to Medicare enrollment changes, there are timeframes to abide by. Here are the main registration periods:

Initial Enrollment Period (IEP)

This is a 7-month window when you first become eligible for Medicare. It begins three months before you turn 65, includes your birthday month, and ends three months after your 65th birthday. During this period, you can sign up for Medicare Part A and Part B.

Special Enrollment Period (SEP)

If you didn’t sign up for Medicare Parts A and B when you were first eligible because you were covered under a group health plan based on current employment (either yours, your spouse’s, or a family member’s if you are disabled), you can sign up during a Special Enrollment Period.

The SEP lasts for eight months and begins the month after your employment ends or the group health plan insurance based on current employment ends, whichever comes first.

General Enrollment Period (GEP)

If you didn’t sign up for Medicare Parts A and B during your IEP and you don’t qualify for an SEP, you can enroll during the General Enrollment Period, which is January 1 to March 31 each year. Coverage starts the following month, but you might have to pay a late enrollment fee.

What Is a Medicare Advantage Plan?

Medicare Advantage, also known as Part C, is an alternative to original Medicare provided by private insurance providers. These plans bundle together Part A, Part B, and usually Part D. Medicare Advantage plans often offer additional benefits like dental, vision, hearing, and wellness programs.

While these plans can be attractive due to their extensive coverage and extra benefits, they also come with limitations and potential drawbacks that are leading some people to reconsider their enrollment.

Coverage Under Medicare Advantage Plans

Medicare Advantage plans cover everything that Original Medicare covers and may offer extra benefits. Here’s a breakdown of typical coverage:

Hospital Stays: Includes all services covered under Part A.

Medical Services: Includes all services covered under Part B.

Prescription Drugs: Many plans include Part D coverage.

Additional Benefits: May include dental, vision, hearing, fitness programs, and more.

Ways To Know If You Need Additional Medical Coverage

If you have standard Medicare, you may assume that it’s enough coverage. However, it may not be. Below are ways to determine if you need additional insurance:

1. High Out-of-Pocket Costs

If you find yourself frequently paying large sums for doctor visits, hospital stays, or prescription drugs, it may be a sign that you need additional coverage. Having more insurance can help to reduce these out-of-pocket expenses. The monthly premium that you pay for the extra coverage will be well worth it.

2. Chronic Health Conditions

If you have a chronic health condition that requires regular medical attention or medications, additional insurance can help. It’ll cover the ongoing costs associated with managing your condition.

3. Frequent Specialist Visits

If you need to see specialists for your health issues, the expenses can add up quickly. Extra insurance can help to cover specialist visits that Medicare might not fully pay for.

4. Extended Hospital Stays

Basic Medicare covers a limited number of hospital days. If you expect to need extended hospital stays, more insurance can cover the costs beyond what Medicare provides.

5. Dental, Vision, and Hearing Care

Basic Medicare does not cover most dental, vision, and hearing care. If you need these services, a Medicare Advantage plan or a supplemental insurance policy might provide the coverage you need.

6. Home Health Care Needs

If you require home healthcare services that are not fully covered by Medicare, additional insurance can help. It’ll pay for the services, ensuring you receive the care you need at home.

7. Prescription Drug Costs

If your prescription drug costs are high, you might benefit from a Medicare Part D plan or another type of supplemental insurance. Medicare Part D may minimize the price of your medications.

8. Travel Plans

If you travel frequently, especially outside the United States, you may need additional coverage. Basic Medicare typically does not cover medical costs incurred abroad, so travel insurance or a Medicare Advantage plan with international coverage can be beneficial.

Why Are People Leaving Medicare Advantage Plans?

Despite the appeal of additional benefits and potentially lower costs, there are several reasons why people are opting out of Medicare Advantage plans. Here’s why:

Limited Network of Providers

One of the main reasons people leave Medicare Advantage plans is the restricted network of healthcare providers. These plans often require members to use a network of doctors and hospitals to receive the highest level of coverage. This can be particularly problematic for those who travel frequently or live in rural areas where the network might be limited.

High Out-of-Pocket Costs

While Medicare Advantage plans have lower premiums, they often come with higher out-of-pocket costs. Copayments, coinsurance, and deductibles can add up quickly, especially for those who need frequent medical care. These costs can become burdensome and unpredictable.

Prior Authorization Requirements

Medicare Advantage plans often require prior authorization for certain services and treatments. This means that beneficiaries need to get approval from their plan before receiving specific types of care. This can lead to delays in treatment and frustration for those needing prompt medical attention.

Changes in Coverage and Benefits

Plans can change their coverage, benefits, and costs from year to year. This can create uncertainty and instability for beneficiaries who rely on consistent access to specific services. If a plan changes its network or drops a favored doctor, it can disrupt the continuity of care.

Medicare Plans 2024: Finding Medicare Coverage Options

When selecting Medicare supplement plans, it’s important to consider the reliability and financial stability of the insurance providers. These companies are considered some of the best:

Blue Cross Blue Shield (BCBS)

Reputation and Reliability: BCBS is one of the most trusted names in health insurance, with a strong reputation for reliability and customer satisfaction.

Wide Network: BCBS offers extensive provider networks, ensuring that beneficiaries have access to a broad range of healthcare providers and facilities.

Plan Options: They provide a variety of Medigap plans that cater to different needs and budgets, allowing beneficiaries to choose a plan that best suits their healthcare requirements.

Customer Service: Known for excellent customer service, BCBS provides robust support to help customers understand their coverage and benefits.

Humana

Variety of Plans: Humana offers a broad selection of Medigap plans, giving beneficiaries the flexibility to choose the coverage that best fits their needs.

Additional Services: Humana often includes extra services and resources, such as fitness programs and preventive care, as part of their plans.

Reputation: Humana is well-regarded for its commitment to customer service and its focus on improving the health and well-being of its members.

Ease of Use: They offer user-friendly tools and resources to help beneficiaries manage their plans and health care more effectively.

Programs That’ll Help To Pay for Medicare Healthcare Costs

Several programs exist to help people with limited income pay for Medicare costs. These include:

Qualified Medicare Beneficiary Program: Helps pay for Part A and Part B premiums, deductibles, coinsurance, and copayments. To qualify, you must have income below certain limits, which vary by state.

Specified Low-Income Medicare Beneficiary Program: Helps pay for Part B premiums. Eligibility requirements are similar to the QMB program but with slightly higher income limits.

Qualifying Individual Program: Also helps pay for Part B premiums. You must apply for this program each year, and assistance is given on a first-come, first-served basis. Income limits are higher than the SLMB program.

Qualified Disabled and Working Individuals Program: Helps pay the Part A premium for certain disabled individuals who are working. Eligibility is based on having income and resources below certain limits.