Skip to content
SuperMoney logo
SuperMoney logo

Are In The Wrong Medicare Advantage Plan? 5 Things To Look Out For

Last updated 04/02/2024 by

Benjamin Locke

Edited by

We describe the importance of annually evaluating your Medicare Advantage plan to ensure it meets your healthcare and financial needs. We outline the process for choosing a plan, signs that you might be in the wrong plan, and considerations for deciding to switch plans.
If you’re experiencing higher than expected costs, issues with medication coverage, difficulty accessing preferred healthcare providers, or if you enrolled based on misleading information, you might be in the wrong Medicare Advantage plan. These signs suggest your current plan may not align with your healthcare needs or financial situation. Considering a switch during open enrollment could further indicate that your plan is not the best fit for you. It’s important to assess your plan’s coverage and costs annually to ensure it meets your needs.

5 Signs you might be in the wrong Medicare Advantage plan

  • Unexpected Costs: Paying more than expected for premiums, copays, or out-of-pocket expenses suggests your plan may not suit your financial needs.
  • Coverage Issues with Medications: Difficulty with medication coverage, especially for newer drugs, indicates your plan may not meet your health requirements.
  • Difficulty Finding Providers: Trouble finding in-network providers or covered doctors and specialists means your plan may not align with your healthcare preferences.
  • Enrollment Mistakes or Misleading Information: Choosing a plan based on incorrect information or misunderstandings suggests it might not be the right choice for you.
  • Considering a Switch During Open Enrollment: The desire to explore other plans during open enrollment signals dissatisfaction with your current plan’s coverage, costs, or provider network.
Many people enroll in Medicare Advantage plans without fully exploring their options or noticing changes to their existing plans, as noted by KFF. With the start of a new year, you might find that the plan chosen during Medicare’s fall open enrollment doesn’t suit your needs anymore, or your existing plan has undergone changes.
Medicare Advantage’s open enrollment period from January 1 to March 31 allows members to switch plans or revert to Original Medicare. This period is specifically for those already in a Medicare Advantage plan, allowing them to adjust their coverage as needed, explains David Lipschutz from the Center for Medicare Advocacy.

Get Competing Personal Loan Offers In Minutes

Compare rates from multiple vetted lenders. Discover your lowest eligible rate.
Get Personalized Rates
It's quick, free and won’t hurt your credit score

How to choose a Medicare Advantage plan

When choosing a Medicare Advantage plan, it’s essential to evaluate several key factors to find the best fit for your healthcare needs and preferences. Here are the aspects to consider:
Network Size: The breadth of the plan’s network directly impacts your ability to see your preferred doctors and specialists without incurring extra costs. Larger networks offer more choices but always verify that your current healthcare providers are included.
Extra Perks: Many Medicare Advantage plans offer additional benefits not covered by Original Medicare, such as dental, vision, and wellness programs. These perks can significantly enhance the value of a plan, so consider what extras are important to you and whether the plans you’re considering offer them.
Low-Cost Plan Availability: Budget is a crucial consideration for many when selecting a Medicare Advantage plan. Look for plans that offer low or no monthly premiums without compromising on the quality of care. However, be mindful of the trade-off between lower premiums and potentially higher out-of-pocket costs.
Local Support: Access to local customer service and support can be invaluable, especially when navigating healthcare needs or resolving issues. Some plans, like those offered by UnitedHealthcare, Aetna, Humana, and Blue Cross Blue Shield, are known for their robust customer support networks.

Evaluating your current coverage

Assess your current plan by checking if your preferred healthcare providers are in-network and if your medications are covered. Consider upcoming health needs, such as surgeries or treatments, and how they align with your plan’s coverage. Lifestyle factors, like travel plans, should also influence your decision, as some plans offer extended networks or travel benefits.
Evaluating your current Medicare Advantage plan is a critical step to ensure it still meets your healthcare needs and preferences. Here’s how to thoroughly assess your coverage:
Provider Network: Start by verifying that your preferred doctors, specialists, and hospitals are included in your plan’s network. In-network providers generally offer services at a lower cost compared to out-of-network providers, which can significantly affect your healthcare expenses.
Medication Coverage: Review your plan’s formulary to ensure that all your current medications are covered. Pay special attention to any changes in coverage for your prescriptions, including whether any medications have been moved to a different tier, affecting your out-of-pocket costs.
Upcoming Health Needs: Anticipate any significant health needs you may have in the near future, such as surgeries, treatments, or regular therapies

Medicare Advantage open enrollment options

During open enrollment, you can switch to another Medicare Advantage plan or opt for Original Medicare with a Part D prescription drug plan. However, switching to Medicare Supplement Insurance (Medigap) may be restricted due to medical underwriting requirements after the initial enrollment period.

Deciding to switch plans

Deciding to switch Medicare Advantage plans is a significant decision that can impact your healthcare experience and costs. Here are detailed considerations to guide you through this process:

Coverage for primary care providers and specialists

If you discover that your primary care provider, specialists, or preferred healthcare facilities are no longer in-network, it may lead to higher out-of-pocket costs for you. The convenience and comfort of continuing with healthcare providers who are familiar with your medical history are invaluable. If your current plan no longer supports this, it might be time to look for a new plan that includes your preferred healthcare providers in its network.

Essential Medication Coverage:

Changes in your plan’s formulary can affect coverage for your necessary medications. If your plan has dropped coverage for essential prescriptions or placed them on a higher tier, resulting in increased costs, use the plan finder tool. This tool allows you to input your specific medications and compare how different plans cover them, including copays and whether any restrictions apply, helping you find a plan that better meets your medication needs.

Evaluating plan perks versus essentials:

While additional benefits like dental, vision, and wellness programs can be attractive, they shouldn’t be the sole reason for choosing a plan. Prioritize plans based on their coverage of your healthcare essentials—such as provider networks, medication coverage, and cost-sharing measures. A plan with all the perks but lacking in critical areas of coverage might end up costing you more in the long run.

Overall fit with healthcare needs

Assess how well your current plan aligns with your overall healthcare needs, including any expected changes in the coming year. Consider factors like the plan’s network size, out-of-pocket costs, coverage limitations, and customer service quality. Your health needs can evolve, and your Medicare Advantage plan should be able to accommodate these changes effectively.

Using tools and resources

Take advantage of resources like the plan finder tool and consultations with licensed insurance agents who specialize in Medicare. These resources can provide personalized advice and help you navigate the complexities of Medicare coverage, ensuring you make an informed decision.

Key takeaways

  • Reviewing your Medicare Advantage plan annually is crucial to ensure it aligns with your healthcare needs and financial situation.
  • Key factors to consider when choosing a Medicare Advantage plan include the size of the provider network, availability of extra perks, plan costs, and local support.
  • Signs you might be in the wrong plan include unexpected costs, coverage issues with medications, difficulty finding in-network providers, and enrollment based on misleading information.
  • When deciding to switch plans, evaluate the coverage for primary care providers and specialists, medication coverage, and the overall fit with your healthcare needs, using tools like’s plan finder.

SuperMoney may receive compensation from some or all of the companies featured, and the order of results are influenced by advertising bids, with exception for mortgage and home lending related products. Learn more

Loading results ...

Share this post:

You might also like