Seniors to Lose Medicare Choices in 10 Days

There’s a looming deadline for seniors who wish to change their Medicare Advantage plans.

Everyone looking to switch plans must update their coverage by March 31 or wait until the fall.

More than half of seniors are on Medicare Advantage plans, which differ from traditional Medicare because they are private and bundled. While there may be pros to some Medicare Advantage plans, they typically have smaller provider networks and require beneficiaries to stick with in-network doctors.

“Some seniors quickly find Medicare Advantage has its disadvantages, too,” Marvin Musick, the co-founder and chief educator of MedicareSchool.com, told Newsweek. “If you are one of them, this is the time to reevaluate your options. Unfortunately, too few Americans know about this window of time when they are allowed to make changes to their Medicare Advantage plans.”

Christopher Westfall, the founder of the Senior Savings Network, told Newsweek that because of the network challenges, he’s seen thousands of clients attempt to return to traditional Medicare after using Medicare Advantage.

“In the vast majority of cases, this has been possible,” Westfall said. “The underwriting is what makes it tricky. Many do not realize that after their initial election period, when first eligible for Medicare, they will have to go through underwriting questions in order to qualify for a Medigap plan.”

To fully meet the deadline, applicants must interview with Medigap underwriters, who will render a final decision on the coverage, Westfall said. All of this must take place before March 31.

He continued: “It is emotionally difficult for our agents to be talking to seniors across the country who call in wanting to get off of their Advantage plan, and then go through the underwriting explanation only to find out that they have had a significant problem with their Advantage plan that was the result of a medical condition that also now prevents them from qualifying for a Medicare Supplement.

“We then have no choice but to direct them to the best-suited Advantage plan in their area. It is devastating news to have to deliver, yet we do it every day.”

Overall, most seniors are happy with their coverage, according to a Retirement Living survey of 351 Advantage members in 2023. But some still reported issues involving out-of-pocket costs, telehealth and online access to care. These struggles can cause many to make slight changes to their Advantage plans.

According to Chris Fong, the CEO of Smile Insurance Group, for most seniors, it comes down to their doctors no longer accepting their plan or medications becoming too costly or unavailable.

“Some people will change their plan because they had a bad experience with the plan, but this is less common,” Fong told Newsweek.

Medicare Advantage beneficiaries can change their enrollment only during the spring and fall windows. So these are also the only times they can switch back to traditional Medicare.

This year, those who aren’t already on an Advantage plan will need to wait for the fall open enrollment period, which runs from October 15 to December 7. The spring enrollment started in January and ends this month, so seniors looking to update their healthcare coverage should take action now.

Some plans come with zero premiums, while others carry higher costs if beneficiaries want to be in a specific doctor’s network. The plans that boast the lowest out-of-pocket costs still come with risks, especially if beneficiaries are looking for specific providers, procedures or medications.

“There has been much scrutiny of Medicare Advantage due to restrictive networks and prior authorization practices that can delay or deny care,” Musick said. “At the same time, these are often more affordable plans and can be a good option for some people.”