How to Get Out of Medicare Advantage Nightmares

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

Medicare Advantage plans are attractive to many, thanks to their often low or no additional premiums and extra benefits, such as dental and vision coverage. But while they are a good fit for many people, there’s more to the story.

If you’re stuck in a plan that’s more of a nightmare than a help, you’re not alone. But there’s a clear way out, and we’re here to guide you through it. Let’s dive into how you can leave those Medicare Advantage nightmares behind and find a plan that truly fits your needs.

Navigating the Choppy Waters of Medicare Advantage Plans

If you’re leaning towards Medicare Advantage or already enrolled, it’s important to take a closer look before you make any decisions.

Beyond the appealing benefits, you might be surprised to find hidden costs or network restrictions. A quick look can help you avoid surprises and ensure your plan really meets your needs.

Choosing a Doctor – Understanding Network Limits

Imagine having the freedom to choose nearly any doctor, a hallmark of Original Medicare where about 90% of doctors in the U.S. are accessible. 

Switching to a Medicare Advantage plan introduces a different scenario. These plans operate with specific networks, and stepping outside these boundaries can lead to higher costs or even lack of coverage. This is important to know if you require specialists or if travel is a regular part of your life.

Out-of-Pocket Costs – What You Might Pay

Medicare Advantage plans come with an out-of-pocket maximum, which sounds like a safety feature until you compare it to alternatives like Medigap. 

For example, with a Medigap Plan G, after meeting your Part B deductible, your costs for covered services could be minimal. The difference in potential out-of-pocket expenses can be stark.

Prior Authorization – Navigating Approval Processes

Medicare Advantage plans often require prior authorization for certain services or equipment, adding a layer of bureaucracy to accessing care. 

This contrasts with Original Medicare’s more straightforward approach, where prior authorization is not a typical hurdle, making it easier and quicker to receive needed services.

Annual Changes – Keeping Up with Your Plan

Medicare Advantage plans can change annually—altering networks, costs, and the benefits offered. 

Not all changes are detrimental; sometimes, they can improve your plan. Review your plan’s details each year during the Open Enrollment Period to ensure it still meets your needs without any surprises

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: 

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!

Get a Free Medicare Supplement Quote

How to Get Out of Your Medicare Advantage Nightmare

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

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:

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

Senior open enrollment is a 6-month period that starts the month a 65 or older enrolls in Medicare Part B. During this period, there’s no preexisting conditions held against you. This also applies to “Guaranteed Issue Rights.” The open enrollment period has been extended through December 31, 2024. 

Protect Yourself from the Medicare Advantage Nightmare

If you are struggling with the limitations of your Medicare Advantage Plan, particularly as your healthcare needs evolve with age, remember that change is within reach. 

• Reevaluate your plan: Take a close look at how your Medicare Advantage plan stacks up against your current and future health needs.
• Explore alternatives: Don’t overlook the potential benefits offered by Traditional Medicare, Medigap, and Medi-Share 65+.
• Timing is key: Make a note of the open enrollment periods and be mindful of the specific regulations and waiting periods for pre-existing conditions that apply in your state.

For a 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!

By taking these steps, you can move beyond the constraints of Medicare Advantage plans and find a solution that better serves your healthcare needs, ensuring a smoother and more secure healthcare experience. Let’s turn those Medicare Advantage nightmares into a thing of the past.

Medicare Advantage FAQ

What are the disadvantages of Medicare Advantage plans?

Some disadvantages are that enrollees must commit to their plan for an entire year, which may restrict their ability to adapt to changing health needs. 

The network of healthcare providers is also subject to change, as doctors can leave the network at any time, potentially disrupting continuity of care. The requirement for referrals and prior authorizations adds another layer of complexity, potentially delaying access to necessary healthcare services.

Why are network limitations in Medicare Advantage plans problematic?

The restricted networks in Medicare Advantage plans can be a significant hurdle, especially if you need specialized care or travel frequently. 

Unlike health sharing plans, which typically allow you to see any provider, Medicare Advantage can leave you without coverage or facing higher costs when you step outside their network.

Why are Medicare Advantage plans being pushed so hard?

Medicare Advantage plans are heavily marketed for a few key reasons. 

First, their low or no monthly premiums make them an attractive option, especially for individuals on fixed incomes looking for affordable healthcare coverage. Additionally, these plans often include benefits and services not offered by Original Medicare, such as dental and vision care, adding significant value.

Is it easy to switch back to Original Medicare or join a health sharing plan from Medicare Advantage?

Switching back to Original Medicare from Medicare Advantage is permissible during specific enrollment periods, offering a window to reconsider your options, including the more flexible and community-oriented option of health sharing plans.

How do out-of-pocket costs compare between Medicare Advantage and health sharing plans?

Medicare Advantage plans can surprise you with high out-of-pocket costs due to deductibles, co-payments, and coinsurance. In contrast, health sharing plans often promote more predictable and transparent sharing guidelines, potentially offering more financial stability and less surprise.

Are medication restrictions a concern with Medicare Advantage plans?

Yes, the formularies in Medicare Advantage plans can limit access to necessary medications, imposing barriers like prior authorization or step therapy. 

What can I do if my Medicare Advantage plan changes for the worse?

Yearly changes in Medicare Advantage plans can affect your coverage negatively. 

While you can switch plans during designated periods, this uncertainty contrasts sharply with the stability of health sharing plans, where community needs drive decisions rather than profit.

How does resolving issues with Medicare Advantage plans compare to health sharing plans?

Addressing grievances within Medicare Advantage plans can be a complex and frustrating process. Health sharing plans often have a more personalized approach, with member support and community guidelines helping to resolve concerns in a manner aligned with shared values and mutual aid.

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?