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Common Reasons for Leaving a Medicare Advantage Plan

misinformation can cause you to leave a Medicare plan

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Medicare Advantage (MA) plans are packaged alternatives to Original Medicare that are sold by private insurers.  

At Bobby Brock Insurance, we can answer Medicare enrollment questions, sort out your coverage options, and provide ongoing support. If your circumstances change or you experience problems, we may suggest switching to a different Medicare plan. 

So, when can you leave a Medicare Advantage plan? Why do people disenroll from an MA plan? We address these questions below.

When Can You Disenroll from a Medicare Advantage Plan?

It’s best to review your MA plan each year to make sure it’s suitable for your needs. 

When you need to make changes, you can do so during these annual periods: 

  • Open Enrollment Period (aka Annual Election Period) from October 15 to December 7
  • Medicare Advantage Open Enrollment Period (MA OEP) from January 1 to March 31
  • Special Election Period — only under certain conditions

These periods allow you to switch to a different MA plan, switch from MA to Original Medicare, or join a Part D drug plan. 

Why Do Consumers Disenroll from a Medicare Advantage Plan?

In some cases, people may disenroll for multiple reasons. Here are the most common motives for leaving a Medicare Advantage plan:

Note: This information was taken from a Medicare Rights Center report. 

Cancer or Serious Illness

Severe illness can prompt someone to leave a Medicare Advantage plan. Sometimes, people choose an MA plan only to encounter a health crisis later. There are a few causes of illness-related disenrollment requests: 

  • Provider access problems — limitations of private plan networks (explained more below) 
  • Erroneous claim that premiums haven’t been paid (in this case, the plan initiates disenrollment)
  • High cost-sharing associated with cancer treatment — the out-of-pocket maximum doesn’t always apply, which results in higher-than-anticipated expenses
  • Coverage restrictions for Part D drugs

More on Provider Access Problems

Most cancer disenrollment cases are due to provider access issues. For example, a cancer diagnosis often requires chemotherapy and complex surgical procedures performed by a specialist. If the preferred doctor is not in the MA plan’s network, the patient will need to switch to a different Advantage network that includes the chosen physician. Or, the person can disenroll from their current plan and get coverage through their spouse’s employer.

Unfortunately, there’s a lot of confusion about network providers, and MA plans can drop providers anytime. 

HMO and PPO Plans

If you enrolled in an HMO Advantage plan, you couldn’t see doctors outside the plan’s network. In this case, you could switch to a PPO plan because it allows you to go out-of-network.

Misinformation/Marketing Abuse

Misinformation/marketing abuse before enrolling is another reason for leaving an MA plan. It refers to users who were registered based on deception or fraud, or the terms of the plans’ benefits were misinterpreted. It could look different for various people:

  • You may feel that you were misled about which care would be covered or the restrictions on provider access in-network plans.
  • You were enrolled in an MA plan while the carrier led you to believe you were getting supplemental coverage or a stand-alone drug plan.

If you’re misinformed before you enroll, it can lead to: 

  • Coverage denials for medical services under your new plan 
  • Your prescription drugs not being covered as promised
  • Higher cost-sharing than you expected 

Medicare Advantage at Bobby Brock Insurance

If you’re seeking an alternative to original Medicare, consider Medicare Advantage plans, which offer added benefits. The agents at Bobby Brock Insurance are ready to help. Contact us to see which Advantage plans and benefits are available in your area. 

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