Why Do People Leave Medicare Advantage for Original Medicare?

01.03.19 09:48 PM By Peter

The reason why you want a broker on your side

This week, researchers released an analysis of patterns in Medicare showing that people with high needs—like significant chronic illness—and people with both Medicare and Medicaid coverage choose to leave their Medicare Advantage (MA) plans more often than people without similar health issues or Medicaid coverage. The researchers sought to discover why these patterns exist and what the implications might be for MA going forward.

While most people with Medicare get their coverage from Original Medicare, some choose Medicare Advantage plans instead. MA plans are private health plans that are paid a fixed amount per person to provide all of the same benefits as Original Medicare. They can also offer some additional benefits, like limited dental and vision coverage, and have an out-of-pocket cap on beneficiary expenses. However, MA plans also have different coverage rules, like requiring enrollees to remain in-network for services. People with Original Medicare can choose any doctor that accepts Medicare. People with MA must choose from the list of doctors that contract with the MA plan. Similarly, though MA plans must cover the same health services as Original Medicare, people with MA may have to pay more for certain services or take additional steps to obtain needed care.  For example, an MA plan may require a referrals to see a specialist or require providers to request prior authorization before some services are covered.