Four in 10 Medicare Advantage Enrollees Misunderstand Their Coverage

Medicare Advantage (MA) plans are popular. 2021 MA enrollment totaled 26.4 million people, or 42% of total Medicare beneficiaries (62.7 million). Enrollment is expected to grow to 50% in less than ten years.

They are popular for several reasons: the promises of added benefits, lower or no additional premiums and in some cases zero premiums or a refund of Part B premiums, included Part D.

However, all is not rosy. In some cases in-patient hospital stays will actually cost the beneficiary more than traditional Medicare.

Also …

39% of retirees enrolled in a Medicare Advantage Plan don’t know they have to stay within network to receive health care and another 11% are not sure.

Source: Four in 10 Medicare Advantage Enrollees Misunderstand Coverage: Survey –

That so many of those enrolled don’t pay attention to the common restrictions when accessing health care is disturbing and they may find themselves with unexpected costs.


Most of the funding comes from Medicare. The amount of the monthly payments depends on two main factors:

  • the healthcare practices in the county where each beneficiary lives, which influences a procedure called the bidding process
  • the health of each beneficiary, which governs how Medicare raises or lowers the rates, in a system known as risk adjustment

It’s a bit more complicated than that. The fact is the ability for MA plans to deliver on their promises comes in part from their ability to maximize what they can obtain from Medicare. Take a closer look at the process.


  1. An important item to consider is if you will change which state(s) you will live in retirement. There is a couple states that will allow changing medigap plans, but most don’t. So if planning to go on original Medicare, then your medigap plan selection most likely a critical choice because on underwriting. Being healthy today, may not be the case in 10-15 years. Penny wise today may be pound foolish in the future.

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  2. I am 5 years away from signing up for Medicare. There are too many choices and in some cases too few options due to plans that are offered in my area and limited by providers. I watched some YouTube videos on the subject during the last open enrollment period. The presenters usually do a white board comparison presentation on plan types which I have found helpful. I am learning the right questions to ask. When I am 64, I’ll start reading the fine print but I won’t waste my time now in case their plans change. From watching the videos I have learned that due to pre-existing conditions you may not be allow to change plans after the initial sign up and then go back to your old advantage plan again later. I also found that it might be important to have two different plans, one for my wife and a different one for me depending on our coverage needs. I don’t even know if that is possible or how that works.
    The learning curve can be quite expensive if you pick the wrong plan. Last year, I had some issues with my knee and back. I used my EPO plan quite heavily which I have had for a few years now. It isn’t the cheapest plan but it covers my needs. Then last fall, claims were being denied. I knew the rules, and procedures, and the covered providers but I still had to put my treatment on hold because the out of network and out pocket expenses were piling up. I knew I was covered from prior experience and it took me about 4 days to get it straighten out. It was some coding issue between one provider and Horizon.
    I will be reading the fine details when it becomes my time to sign up. I can’t afford making a mistake in coverage. The hardest part is trying to figure out what my coverage will be 5, 10, 15 years after signing up and will my plan be the best plan for my illness? How long is the Medicare learning curve if you are healthily?

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  3. I’m not surprised that 39% don’t know and 11% aren’t sure if they have to stay in network. The bottom half of the population is oblivious to most things and that includes Medicare advantage plans as well as regular Medicare. They don’t read and don’t want to take the time to understand something as important to them as Medicare. I know that’s harsh but I believe accurate.


      1. In response to the three previous comments, I prepare tax returns for a few people and I notice the retirees who have Medicare Advantage have enough out of pocket expenses that they add up to more than 7 1/2% of their Adjusted Gross Income, but since the standard deduction is so high they don’t itemize. And retirees like me with Medicare Plan F or G, (ignoring prescription drugs now), our out of pocket costs other than the premiums are basically zero. Note I said Plan F or G. G has a small deductible plus premiums. F doesn’t, but new enrollees can’t get F any longer. Drug costs are another topic though and can be expensive. One other situation that people with Medicare Advantage don’t always understand is when you’re traveling, you’re out of network and if your plan is restrictive on that, every medical expense while traveling will cost you more (compared to in-network). I also notice all the people I know who have Medicare Advantage love them. And everyone who has regular Medicare with a supplement love their choice. So, do you want known costs up front plus have to deal with a drug plan or pay something out of pocket whenever you need medical care.

        One person I know didn’t do any research when they went on Medicare and chose plan A because it’s really cheap but doesn’t cover anything. Then she got breast cancer. Needless to say, she had very little coverage and at the next renewal, she couldn’t change plans because after the first initial enrollment, insurers can require medical history and can refuse your requested change of plans. They can’t do that the first time you choose to go on Medicare. So, be very careful and understand your complicated choices.

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