Why are people leaving Medicare Advantage plans?

People are leaving Medicare Advantage (MA) plans due to difficulty accessing care (like provider network limits, prior authorizations), dissatisfaction with care quality, issues with plan generosity, and challenges with specific plans, especially as their health needs grow, often leading them back to Original Medicare for broader choice but sometimes finding it hard to switch. Healthier individuals might join for perks, but sicker enrollees often face network restrictions, approval hurdles, and poor experiences, prompting disenrollment, notes KFF and ElderLawAnswers.

Can I drop my medicare advantage plan and go back to original Medicare?

Yes, you can drop your Medicare Advantage (MA) plan and return to Original Medicare, typically during the Annual Enrollment Period (AEP) (Oct 15–Dec 7) or the MA Open Enrollment Period (OEP) (Jan 1–Mar 31), though you may qualify for a Special Enrollment Period (SEP) if you move or have other qualifying life events, but be aware you'll need to get a Part D plan and might want a Medigap plan to help with costs. 

Why do people say not to get a Medicare Advantage plan?

People warn against Medicare Advantage (MA) plans due to limited doctor/hospital networks, complex pre-authorization for care, higher potential out-of-pocket costs for serious illnesses, annual plan changes (benefits/networks), denials of care, and difficulty switching back to Original Medicare with a Medigap plan later, especially if you become sick. While MA offers extra perks (dental, vision, low premiums), these restrictions can be burdensome, prioritizing insurer profits over patient freedom, making it risky for those with ongoing health issues. 

Why are doctors dropping Medicare Advantage?

Doctors and hospitals are leaving Medicare Advantage (MA) plans primarily due to low reimbursement rates, burdensome prior authorization requirements leading to denied care, slow payments, and excessive paperwork, all impacting finances and patient care quality, with many providers finding the administrative load outweighs the benefits. They seek better payment rates or leave networks to avoid financial strain and care delays, even if it disrupts patient access to preferred providers like the Mayo Clinic or NewYork-Presbyterian. 

Why are seniors losing Medicare Advantage plans?

The issue is there are too many crappy companies preying on the desperation of people, providing low payments to providers, have fewer in network providers (especially in rural towns) and withholding payments to providers to control costs, leading to more providers leaving the network.

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Is it better to have plain Medicare or Medicare Advantage?

Neither Original Medicare nor Medicare Advantage (MA) is universally "better"; the best choice depends on your healthcare needs, budget, and preference for provider choice, with Original Medicare offering nationwide provider freedom but requiring separate drug/supplement plans, while MA provides all-in-one coverage with networks and extra benefits like dental/vision but often requires referrals and has regional limits. 

Why is UnitedHealthcare cancelling Medicare Advantage plans?

UnitedHealth now plans to exit unprofitable Medicare Advantage and Affordable Care Act products, raising rates on ACA plans by about 26% alongside other health insurers. They're not fixing the business model, but rather purging the patients who make it look broken.

What is the biggest disadvantage of Medicare Advantage?

The biggest disadvantage of Medicare Advantage (MA) plans is often the limited provider networks and restricted access to care, requiring prior authorizations, referrals, and potentially forcing you to switch doctors or travel far for specialists, creating barriers to timely treatment, especially for complex health issues, with potential for denials and mid-year changes. While MA offers extras like dental/vision, these networks can significantly limit choice and create hurdles for consistent, high-quality care compared to Original Medicare. 

Which medicare advantage plan denies the most claims?

Centene (Wellcare) and CVS Health (Aetna) have faced scrutiny for high prior authorization denial rates in Medicare Advantage (MA) plans, with reports showing they had the most denied requests in 2023, though many denials were overturned on appeal, indicating issues with their strict criteria, while UnitedHealthcare also faces lawsuits and uses technology that has led to increased denials, especially for post-acute care, highlighting systemic challenges with MA plan claim approvals. 

Why are hospitals refusing Medicare Advantage plans?

Across the country, health systems report that Medicare Advantage's growing administrative burden — from denied authorizations to delayed reimbursements — has become unsustainable. Some hospitals have already ended their contracts; others are limiting participation to only a few select plans.

What states have the worst Medicare Advantage plans?

States often cited for weaker Medicare Advantage performance include Louisiana, Mississippi, Kentucky, West Virginia, and Florida, due to challenges with care access, provider shortages, and quality issues like higher rates of avoidable hospitalizations and inappropriate medication prescriptions, though specific rankings vary by report and focus (e.g., satisfaction vs. overall system). Other states like New York, California, Texas, and Michigan appear on lists for low member satisfaction with specific plans, not necessarily the whole state's system. 

What is the best health insurance for seniors on Medicare?

There's no single "best" health plan, as it depends on your needs, but top providers for Medicare Advantage (Part C) include Humana, UnitedHealthcare, Aetna, and BCBS, offering diverse benefits like $0 premiums, extra perks, and strong networks, while Medigap (Medicare Supplement) complements Original Medicare by filling gaps, with popular carriers like AARP/UHC, Anthem, and Cigna providing standardized policies (Plans G, F, N), with personalized choices best found via your State SHIP counselor or broker. 

What is happening to Medicare Advantage in 2025?

In 2025, Medicare Part D plans and Medicare Advantage plans that include prescription drug coverage will feature lower out-of-pocket cost limits and new payment options. Changes include: Annual out-of-pocket cap reduced from $8,000 to $2,000. Elimination of the Medicare donut hole in 2025.

What is the most highly rated Medicare Advantage plan?

There's no single "most highly rated" Medicare Advantage plan nationwide, as ratings vary by location and insurer, but Kaiser Permanente often leads in integrated care markets (like CA) for high CMS & J.D. Power scores. Aetna gets high marks for nationwide reach & ratings, while UnitedHealthcare, Humana, and SCAN Health Plan are consistently strong performers with high CMS Star Ratings and member satisfaction, often offering $0 premium options and extra benefits. 

Is there a penalty for switching from Medicare Advantage to regular Medicare?

No, there's no direct penalty for switching from Medicare Advantage (Part C) back to Original Medicare (Parts A & B), but you risk significant issues: losing drug coverage (Part D penalty if you don't enroll in a separate plan) and potentially being denied or paying much more for a Medigap supplement due to medical underwriting after your initial guarantee period ends. You must switch during specific enrollment periods (Annual Election Period: Oct 15-Dec 7, or MA Open Enrollment: Jan 1-Mar 31). 

Is Medicare Advantage going to be canceled?

If your Medicare Advantage (MA) plan is canceled or discontinued for 2026, you won't lose coverage but must choose a new plan or return to Original Medicare; you'll get a notice in October, can use a Special Enrollment Period (SEP) to switch plans by February, and if you do nothing, you'll default to Original Medicare (Parts A & B) but need to add a Part D plan for drugs, with major insurers scaling back offerings due to payment changes. 

Who is the largest carrier of Medicare Advantage plans?

UnitedHealthcare is the largest Medicare Advantage (MA) provider by enrollment and market share, followed by Humana, with both companies dominating the market, especially in county-level presence, while CVS Health (Aetna) and Elevance Health are also major players, according to recent 2024-2025 data from KFF. UnitedHealthcare leads with nearly 10 million enrollees as of March 2025, offering broad availability and large provider networks, making it a consistent market leader. 

Is Blue Cross or UnitedHealthcare better?

UnitedHealthcare gets slightly higher overall star ratings than BCBS and may offer lower prices, but BCBS might offer a better customer experience.

Which is the best original Medicare or Medicare Advantage plan?

Neither Original Medicare nor Medicare Advantage (MA) is universally "better"; the best choice depends on your healthcare needs, budget, and preference for provider choice, with Original Medicare offering nationwide provider freedom but requiring separate drug/supplement plans, while MA provides all-in-one coverage with networks and extra benefits like dental/vision but often requires referrals and has regional limits. 

Does Medicare Advantage pay 100 percent?

Medicare Advantage plans provide a financial safety net due to a set annual out-of-pocket limit. If your costs reach the limit, then your plan covers 100 percent of your Medicare-covered health care costs for the rest of the year.

What does Dave Ramsey say about Medicare?

Dave Ramsey's Medicare advice centers on planning ahead, understanding enrollment periods to avoid penalties, using Health Savings Accounts (HSAs) if possible, and supplementing Original Medicare with Medigap or Medicare Advantage (Part C) to cover gaps like dental, vision, and long-term care, stressing that mistakes can be costly and recommending expert advice for personalized choices. 

Why does Medicare Advantage have a bad reputation?

People dislike Medicare Advantage (MA) plans due to restrictive provider networks, complex rules like prior authorizations, potential for higher out-of-pocket costs, and annual changes in coverage, which can disrupt care, especially for those with chronic conditions, compared to the stability of Original Medicare. Frustrations also stem from aggressive marketing, misleading information, and the administrative burden placed on doctors, leading to denied claims and slower payments. 

Are seniors going to lose Medicare Advantage plans?

Beneficiaries enrolled in Medicare Advantage and Part D drug plans might lose their coverage as UnitedHealthcare, Humana, and Aetna (CVS Health) scale back offerings for 2026.

Who has the best Medicare Advantage plan for 2026?

There's no single "best" Medicare Advantage plan for everyone in 2026; it depends on your location and health needs, but top-rated carriers often include Aetna, UnitedHealthcare (AARP), Humana, Kaiser Permanente, SCAN Health Plan, and Blue Cross Blue Shield affiliates, recognized for high ratings, wide availability, $0 premium options, and strong supplemental benefits like dental, vision, and fitness. The best plan for you requires comparing provider networks (doctors, hospitals), costs (premiums, copays, max out-of-pocket), and specific benefits available in your zip code. 

Which health insurance company denies the most claims?

While specific rankings vary by data source and year, UnitedHealthcare (UHC) consistently appears as a top insurer for high claim denial rates, often around one-third (33%), alongside companies like Blue Cross Blue Shield of Alabama, with other major players like Cigna, Aetna, and Anthem also facing scrutiny for significant denials, though generally with lower rates than UHC in marketplace data.