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25% of Medicare Advantage Members Report Unexpected Costs

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Medicare open enrollment begins next month, and that means those Medicare Advantage ads can’t be far behind. But do Medicare Advantage (MA) plans really bring all the “advantages” they promise?

In recent years, about 40 percent of Medicare beneficiaries have chosen Medicare Advantage plans over traditional Medicare, and a large majority are reportedly satisfied with their coverage. But this recent article from Kiplinger, written by freelance journalist Joey Solitro, points to a survey in which a significant number of MA beneficiaries – one in four – express some degree of dissatisfaction with their plans, with many reported overbilling and unexpected costs.

Advertising for Medicare Advantage plans is relentless, and for some these plans offer good value. But for us the take-away from this article is, don’t be fooled by marketing hype. As open enrollment approaches, do your homework. Articles like these are a good place to start.

Most Medicare Advantage Beneficiaries Satisfied, but Not All

Writing for Kiplinger, Solitro says, “The majority of Medicare Advantage (MA) beneficiaries responding to a recent survey conducted by Retirement Living said they are satisfied overall with their plans but many also reported issues over telehealth services, overbilling, online and mobile app access and more.”

As we noted above, based on stats from 2021, MA plans had attracted about 26 million enrollees – roughly 40 percent of Medicare beneficiaries. But Solitro says caution is advised.

When considering a Medicare Advantage plan be wary of promises,” he warns. “These private insurance alternatives to Medicare are growing in popularity at the same time that they’re under scrutiny for their sales tactics and coverage.”

Survey Shows Unexpected Medicare Advantage Costs and Co-pays

Solitro describes the Retirement Living survey which collected data from 351 Medicare Advantage beneficiaries. It was conducted to gauge the level of satisfaction of MA policy holders. The median age of respondents was 69.

According to Kiplinger, the survey “found that 71 percent of participants were satisfied with their plans. This includes 61 percent who believe their current coverage outperforms their previous plans.” That’s the good news.

“But about 25 percent of participants reported paying more money than they expected for co-pays and medications,” Solitro writes, “and nearly 25 percent said that service providers or coverage for certain procedures were limited, according to the survey.” That’s roughly 6.5 million dissatisfied policy-holders.

Moreover, cost wasn’t the only source of frustration. “Nearly 20 percent of participants said they had challenges receiving care due to delays caused by the prior authorization process,” says Solitro, “and 10 percent reported that they were overbilled for their plans, the survey found.”

Despite Higher Medicare Advantage Costs, Only 10% Plan to Switch

Surprisingly, even with these poor results, only a small fraction of respondents say they p;lan to change coverage. “Despite those and other concerns,” says the article, “only about 10 percent of participants said that they anticipate changing health insurance plans in the next year, the survey showed.”  It may be that even the frustrated policy-owners don’t relish the headache of switching coverage.

“While some Medicare Advantage plan members felt frustrated with their coverage, most enrollees expressed satisfaction with their benefits,” Retirement Living said in commenting on the survey. “In most cases, enrollees could resolve their greatest sources of frustration with a better understanding of the plan’s offerings and details.”

Top Medicare Advantage Attractions: Lower Cost, Better Coverage

The reasons people gave for choosing Medicare Advantage plans were pretty straightforward, says Kiplinger. “The survey showed that most people are enrolled in MA plans to save money and increase coverage, Retirement Living said. Many survey participants listed factors such as affordable costs and out-of-pocket expenses as well as prescription drug coverage as positively influencing their responses.”

Medicare open enrollment begins October 15th and continues through December 7th, so if you’re dissatisfied with your coverage – or enrolling for the first time – we urge you to start gathering information now. It may very well be that a change to your Medicare coverage is in order. Contact us and we’ll gladly provide some insight and refer you to qualified, objective Medicare specialists who can help you make the right decision.

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(originally reported at

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