Mistakes happen. And sometimes, a relationship is simply a bad match. And so it is with Medicare Advantage plans, as well. Read on to learn how to get out of your Medicare Advantage nightmares.

How to Get Out of Medicare Advantage Nightmares

How to Get Out of Medicare Advantage Nightmares

Many times, people join a Medicare Advantage plan, only to have nightmares that it’s not working out for them.

There are many possible reasons for this. For example: 

  • Customer service may be very poor. 
  • The network of approved doctors doesn’t include any specialists you need in your area. 
  • Your assigned primary care physician can’t see you in a reasonable period of time.
  • The hospital you want to use is out of network. 
  • The mix of benefits isn’t a good fit for you. 
  • The plan raised its premium.
  • The plan cut back on benefits.
  • Your plan changed its contract with Medicare.
  • Your maximum out-of-pocket MOOP exposure is too high.
  • You’d rather go back to Original Medicare (Medicare Parts A and B) and join Medigap.
  • You’d rather be in a health sharing plan.

Whatever the reasons causing your Medicare Advantage nightmares, you’re not alone. Many people are unhappy with the limited networks, substandard care, pre-authorization hassles, and poor customer service in many Medicare Advantage plans.

But it’s never too late to find a plan that fits your specific needs, and we’re here to help!

If you need to dump a bad Medicare Advantage plan, here’s how you can do it:

Get a Free Medicare Supplement Quote

1.) Take Advantage of Your Medicare Advantage “Trial Period”

If you’ve been enrolled in your Medicare Advantage plan for less than a year, I have good news.

When you enroll in a Medicare Advantage Plan for the first time and find that it doesn’t meet your needs, you have a one-time 12-month trial period.

During this period, you can return to Original Medicare. You also have the option to reclaim your previous Medigap policy, provided your carrier hasn’t discontinued the plan.

You can also apply to a different Medigap plan. However, you may face medical underwriting (see below).

2.) Switch During Medicare Open Enrollment

Each year during Medicare Open Enrollment (October 15 to December 7th), you can elect to make the switch back to Original Medicare.

The change will take effect on January 1st of the following year.

You can then apply for a Medigap plan to cover the gaps in Original Medicare coverage (deductibles, co-pays, and coinsurance).

3.) Switch During Medicare Advantage Open Enrollment

Medicare Advantage Open Enrollment runs from January 1st through March 31st every year.

You can also elect to drop Medicare Advantage and return to Original Medicare during this period.

In each case, however, you should consider purchasing additional coverage to help you pay Medicare deductibles, copays, and co-insurance costs.

Protect Yourself: Enroll in Medigap or the Medi-Share 65+ Health Sharing Plan.

That’s where Medigap and Medi-Share 65+ come in: Medigap policies are standardized plans that can help you pay for these costs that Original Medicare doesn’t cover.

And Medi-Share 65+, a non-insurance, Christian health sharing alternative to Medigap, does the same thing – generally at a lower price per month than the most popular comparable Medigap plan, Plan G. 

Click here to learn more about Medi-Share 65+

Medicare Advantage Nightmares: No More Narrow Networks

Both Medigap and the Medi-Share 65+ health sharing plan will free you from the narrow networks of HMO, EPO, and PPO plans that comprise Medicare Advantage.

Neither Medigap nor Medi-Share 65+  imposee limited care networks of authorized providers: you can use your benefits with any doctor that accepts Medicare assignment.

The catch: after a certain time period passes, Medigap plans don’t have to accept you anymore, unless you can pass their medical underwriting criteria.

Individuals who choose traditional Medicare during their Initial Enrollment Period are assured eligibility for a Medigap policy, with their medical history having no impact on the cost.

However, if you initially enroll in a Medicare Advantage Plan and later decide to switch to a Medigap plan, you may face challenges. Coverage could be denied for those with pre-existing conditions, or the premiums could be raised to a point where affordability becomes an issue.

Note: Medigap cannot deny coverage due to pre-existing conditions in the states of Connecticut, Maine, Massachusetts, and New York.

Click Here To Learn How To Self-Enroll in Medi-Share 65+ in Minutes!

Get Expert Guidance for Your Medicare Advantage Nightmares

That’s why it’s a good idea to get expert help before committing to dropping your Medicare Advantage plan.

Med-Share 65+ may exclude pre-existing conditions for up to six months. However, if you enroll during the Medicare Open Enrollment Period, Medi-Share 65+ will waive that provision.

Our experienced MediGap Advisors Personal Benefits Managers can help you understand how to make the transition back to Original Medicare and to a Medigap plan. We can also help you choose the best Medigap plan for your specific needs, as well.

It’s easy… and stress-free! Just click here to make an appointment with a Personal Benefits Manager.

The Medi-Share 65+ Health Sharing Alternative

While Medi-Share 65+ and health sharing in general is not as well known as Medigap, the plan has some terrific advantages for many people:

  • A Community-Oriented Approach. Medi-Share 65+ is a Christian community of like-minded individuals who share medical expenses among members. Many of our clients appreciate the shared sense of belonging and mutual support that aligns with the values and beliefs of its members.
  • Flexibility with Pre-Existing Conditions. Medi-Share 65+ can be more accommodating with pre-existing conditions compared to Medigap plans. After a six-month waiting period, costs related to pre-existing conditions can be shared among members. 
  • Lower Costs: Medi-Share 65+ costs just $99 per month for members aged 65-74, and just $150 per month for ages 75 and up. This compares favorably to the most comprehensive Medigap option currently available to new enrollees, Plan G. 

Click here to learn more about Medi-Share 65+ and how it compares to Plan G.

  • Choose Your Own Doctor. Medi-Share 65+ lets you use your benefits with any doctor. It also has excellent benefits for those living abroad. It’s very popular for that reason among church missionaries and other expats who live outside the U.S. much of the time.

Note: Medi-Share 65+ does not include prescription drug insurance. If you want to join, consider adding a Medicare Part D prescription drug plan. Your MegiGap Advisors Personal Benefits Manager can help you choose a Part D plan that covers the specific drugs you rely on.

Click Here to Learn More About Medicare Part D Plans

It’s important to note that while Medi-Share 65+ may offer benefits aligned with certain individuals’ needs and values, it is not insurance. It’s not structured or regulated the same way.

Instead, Medi-Share 65+ is a non-profit association of like-minded individuals who have agreed to help share one another’s medical expenses.

Get a Free Medicare Advantage Quote

Note for Those With Pre-Existing Conditions

If you love the idea of transitioning to the Medi-Share 65+ Plan, but are hesitant due to the six month waiting period for pre-existing conditions, there’s an easy solution!

You can enroll in Medi-Share 65+ at any time, and keep your current Medicare Advantage Plan for six months until all your pre-existing conditions are shareable under Medi-Share 65+.

Medigap plans are supplemental insurance policies that work alongside Medicare Part A and Part B to cover some of the healthcare costs that Original Medicare doesn’t cover, such as deductibles, coinsurance, and copayments.

Key Takeaways from Medicare Advantage Nightmares

If your current Medicare Advantage Plan isn’t working for you, especially as you get older and require more involved medical services, it’s possible to make a positive change!

  • Evaluate your current Medicare Advantage plan against your healthcare needs.
  • Consider the benefits of Traditional Medicare, Medigap, and Medi-Share 65+.
  • Plan your switch during open enrollment periods, keeping in mind state-specific rules and waiting periods for pre-existing conditions.

For FREE, expert assistance in choosing the right Medicare strategy, contact a Personal Benefits Manager

We can discuss all your options, and make it easy to find an affordable option that better meets your needs. So no more Medicare Advantage nightmares!

For Further Reading: Medicare Plans: Choose Your Doctor for more Healthcare Freedom|Medicare Supplement How To Guide: Making Sure You Have the Coverage You Need!|Medicare 101: How Does Medicare Work?

Tom Lockwood is a Personal Benefits Manager at MediGap Advisors. Tom has a passion for bringing clarity to those confused about Medicare. He is an authority on Medicare, Medicare supplement plans, Medicare Advantage plans, and Part D prescription drug plans. Read more about Tom on his Bio page.