Welcome back to Wellabe’s four-part “Medicare reality check" series. In Part 1, we explored why more people are leaving Medicare Advantage and returning to original Medicare paired with Medicare Supplement insurance. In Part 2, we’ll zoom in on the risks that are driving that shift and the situations where original Medicare + Medigap can offer more stability.
Medicare Advantage (MA) plans are offered by private companies that have flexibility in how they offer them. This means they may come with risks, and unfortunately, the risks seem to be compounding. These include:
Medicare Advantage has long been seen as simpler and cheaper than original Medicare, but AARP reports that 25% of new enrollees were confused about their coverage and later received surprise bills. Rising Medicare Advantage deductibles — nearly doubling in a year — and unstable networks can also increase out of pocket costs, especially with HMOs where out of network charges don’t count toward the maximum.
As insurers seek to improve margins, they’re looking at areas where plans are costing more money than they’re making. This includes regions where populations are lower, meaning enrollment is not as high, but the plan is in high use by policyholders. They’re also making changes in areas where federal monetary reimbursement is low. Those who fall into one of these geographic areas face the risk of losing Medicare Advantage coverage.
People in poorer health report the most problems with Medicare Advantage. They often face frequent prior authorizations, long waits for care, and the frustration of replacing specialists who leave the network. These disruptions can seriously affect treatment for chronic conditions.
According to the Center for Medicare and Medicaid Services (CMS), 98% of providers accept original Medicare. Medicare Advantage networks provide enrollees, on average, access to less than half of providers within their areas.
“There is no network with original Medicare and Medicare Supplement insurance, meaning you don’t have to worry about changes to it, and you have more freedom to choose who you want to provide your care,” says Erin Bueltel, Director of Product Solutions for Wellabe.
One of the biggest benefits of Medicare Supplement insurance is its stability. Policies automatically renew every year, as long as their monthly premiums are paid. When you compare Medicare Supplement vs. Medicare Advantage plans, you’ll discover that they’re both sold by private insurance companies, but Medicare Supplement insurance is “standardized.” This means every company offers plans with the exact same benefits. You only need to choose the right Medicare Supplement letter plan for your needs.
With Medicare’s broad provider network, you’re far less likely to face surprise bills. Annual, published cost schedules make expenses predictable, and most care doesn’t require prior authorization, so Medicare typically pays without extra hurdles. Adding a Medicare Supplement plan can further reduce out of pocket costs.
Knowing preferred doctors and specialists will remain accessible provides peace of mind. Bueltel says that low‑income seniors may still afford a Medicare Supplement option like Plan N, which offers lower premiums in exchange for small copayments.
Being able to receive care without delay — and knowing it will be paid for — can provide security.
Having quick access to insurance coverage that won’t disappear, as well as various solutions to fill its gaps, helps rebuild trust in health care coverage.
Whether leaving a plan voluntarily or being forced due to its discontinuation, moving to original Medicare and the right Medigap plan isn’t complex with these steps:
If your Medicare Advantage plan is discontinued, you have a “guaranteed issue right,” per federal law to a Special Enrollment Period of 63 days that begins the last day of your Medicare Advantage coverage. For example, if your coverage was terminated on Dec. 31, you have until March 4, to change your plan. The letter you received from your insurer — the Annual Notice of Change — should outline some of these details.
If your Medicare Advantage plan is still available, but you want to switch to original Medicare, you can do so during the Medicare Advantage Open Enrollment Period that runs Jan. 1 to March 31.
One of the 10 Medicare Supplement insurance plans can fit your needs. You can compare what’s available in your area on Medicare’s website. After you’ve identified prospective insurers in your area, you’ll want to research those companies and contact each for a price quote.
Once you break down the benefits of Plans G and F, you’ll see why, together, they were selected by 75% of all Medicare Supplement enrollees. Plan F offers the most comprehensive coverage of all the Medicare Supplement offerings, but it’s only available to those who were first eligible for Medicare before Jan. 1, 2020. Plan G is the closest to Plan F. The only difference is that it doesn’t cover the Part B deductible.
Each Medicare Supplement plan offers different benefits, so prices vary. More comprehensive plans usually cost more. After choosing a plan type, you’ll see that premiums differ by insurer and may be influenced by factors like age, gender, and tobacco use.
If both you and your spouse want Medicare Supplement coverage, you’ll need separate policies. Medicare’s plan finder tool can help you locate insurers that offer household discounts.
If you qualify for a Special Enrollment Period, enrolling then can be important. During this window, you can avoid medical underwriting — an advantage for anyone with pre existing conditions who wants to maintain strong coverage.
Continue to “Part 3 — Medicare Advantage coverage gaps in 2026: The checklist that can prevent surprise bills” for a practical Medicare Advantage coverage gap checklist to spot weak areas in dental, drugs, hospital costs, travel, and out-of-pocket maximums before they hit you.
Ready to speak to an agent? Call 866-739-8143 or request a free quote.
View the entire “Medicare reality check” series >
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