Medicare Advantage Enrollment: Exploring the Pitfalls and Risks

SEATTLE, Washington – When Richard Timmins attended a Medicare informational seminar in 2016, he was attracted to the promise of broader and less expensive coverage offered by Medicare Advantage plans. The plans, largely funded by the government but administered by private insurance companies, seemed like a practical choice at the time for the 76-year-old retired veterinarian.

However, after noticing a lesion on his earlobe three years ago, Timmins’ experience with his Premera Blue Cross Medicare Advantage plan led to a rude awakening. Diagnosed with malignant melanoma, Timmins found himself struggling to navigate the limited network of doctors and the potential need for preapproval from the insurer before getting care. Now, he’s looking to switch back to traditional Medicare, only to find himself unable to do so.

With more than half of all eligible people, particularly those 65 or older, enticed by the low premium costs and extra benefits of dental and vision insurance, the enrollment in Medicare Advantage plans has grown significantly over the years. But, concerns about aggressive sales tactics and misleading coverage claims have also increased as enrollees like Timmins find themselves trapped as they grow older and sicker.

As an assistant professor of health services, policy, and practice at Brown University School of Public Health, David Meyers discovered that about 50% of Medicare Advantage beneficiaries left their contract within five years, mostly switching to another Medicare Advantage plan rather than traditional Medicare. This inability to switch freely between the two systems during open enrollment periods has raised concerns within the healthcare system.

The government offers specific enrollment periods every year for switching plans, but Timmins’ experience highlights the challenges faced by many Medicare Advantage enrollees. With limitations on how and when they can switch back to traditional Medicare, these enrollees find themselves stuck in a system that may not meet their evolving healthcare needs.

The growing discontent with Medicare Advantage has raised questions about the long-term feasibility of these private plans for older individuals with chronic conditions. As the conversation around Medicare Advantage continues, the need for a more flexible and accessible healthcare system becomes increasingly apparent, especially for those who find themselves locked into plans that no longer serve their needs.

While traditional Medicare offers more flexibility in terms of choosing healthcare providers, the prohibitive costs of supplemental insurance policies present their own set of challenges for those looking to switch back from Medicare Advantage. With the system’s current limitations, individuals like Timmins find themselves navigating a complex web of healthcare options that may not fully address their needs as they age and require more comprehensive care.

As the conversation around Medicare Advantage and traditional Medicare continues to evolve, it is clear that there is a need for a more accessible and flexible healthcare system that can better serve the needs of older individuals with evolving healthcare needs. Without the ability to freely switch between plans or access affordable supplemental insurance options, many may find themselves trapped in plans that no longer meet their healthcare needs.