Why Are People Leaving Medicare Advantage Plans? Here's What I Learned

If you've watched TV during Medicare enrollment season, you've seen the commercials — $0 premiums, grocery cards, gym memberships, dental benefits.

During enrollment season, Medicare Advantage receives far more advertising than Medigap, so it's often the first option people hear about.

After more than 15 years helping Medicare beneficiaries compare plans, I don't think Medicare Advantage is a bad product. For plenty of the people who sit across from me, it's exactly the right call.

I've enrolled clients in both Medicare Advantage and Medicare Supplement plans, and I continue to recommend both, depending on someone's budget, health, travel habits, and priorities.

But after thousands of conversations — and, more importantly, after hearing from clients after they enrolled, not just before — I usually recommend Medigap when someone can comfortably afford it.

Why Are People Leaving Medicare Advantage Plans?

Quick answer: After helping Medicare beneficiaries compare plans for more than 15 years, the people who call my office about leaving Medicare Advantage usually mention one of four things.

• Their doctor or hospital left the network.
• They were surprised by out-of-pocket costs after a major health event.
• Their plan changed from one year to the next.
• They decided they wanted the flexibility and predictability of Original Medicare with a Medigap plan.

Those are the same patterns you'll see throughout this article — but the reasons aren't the same for everyone.

Many people are still happy with Medicare Advantage, which is why it's important to understand both the advantages and the trade-offs before making a decision.

Why Medicare Advantage Has Become So Popular

Medicare Advantage enrollment has grown rapidly over the last decade, and for good reason.

Many plans carry a $0 additional premium, include prescription drug coverage, and add benefits Original Medicare doesn't — dental, vision, hearing, fitness memberships, sometimes a grocery allowance.

For a healthy retiree on a fixed income, that's a genuinely attractive package. It's a real reason enrollment keeps climbing.

The question I hear most often isn't, "Why would someone choose Medicare Advantage?" It's, "Why are people leaving it?" That's where the rest of this article begins.

Two Very Different Reasons People Leave Medicare Advantage

After working with Medicare beneficiaries for more than 15 years, I've noticed people leave Medicare Advantage in one of two ways.

The first group chooses to leave. They become frustrated with provider networks, unexpected cost-sharing, or annual plan changes.

Or they simply decide they'd rather have the predictability of Original Medicare with a Medigap plan.

The second group doesn't set out to leave. They're forced back into comparing plans because their coverage changed around them.

Their insurance company discontinues the plan, leaves their county, narrows its provider network, or makes changes that force them back into comparing plans.

They weren't unhappy enough to shop — they simply received a letter telling them their coverage was changing.

Those two situations feel very different from the beneficiary's perspective.

But they often lead to the same place: trying to navigate Medicare again after thinking that decision was already behind them.

The Three Biggest Reasons People Leave Medicare Advantage

Over the years, I've noticed three problems that repeatedly lead people to reconsider their Medicare Advantage plan. Those three patterns explain nearly all of the reasons listed above.

Roughly 17% of Medicare Advantage beneficiaries disenroll every year.

Most of those beneficiaries don't switch to Medigap immediately — many simply choose another Medicare Advantage plan that better fits their needs.

That doesn't mean most people are unhappy. It does tell me a meaningful number decide their original choice no longer fits their needs, and in our office, the reasons cluster around three things.

None of these mean Medicare Advantage is a bad choice for everyone. They're just the patterns that show up over and over in the calls we get.

1. Network Restrictions Show Up Later Than Expected

Most of the network calls we get involve an HMO, which is the most common type of Medicare Advantage plan.

HMOs limit which doctors and facilities you can see. If a doctor you're already seeing leaves the network, you're the one who has to find a replacement.

These plans also don't provide routine coverage outside your local area, which catches travelers off guard.

Emergency and urgent care are covered nationwide on nearly every Medicare Advantage plan — it's planned, non-emergency care that gets restricted by region.

2. Cost-Sharing Surprises Show Up During a Health Event

Many agents explain the everyday costs well: a $0 primary care copay, maybe $25 for a specialist.

What often gets skipped is the cost-sharing on the major medical side — hospitalization, outpatient surgery, chemotherapy.

To be fair, the average Medicare Advantage out-of-pocket limit is $5,421 for in-network care in 2026, and plenty of members never spend anywhere near that in a healthy year.

For someone healthy who mostly sees a primary care doctor a few times a year, the lower premium can easily outweigh the added cost-sharing.

It's a different calculation for someone managing a chronic condition or an unpredictable diagnosis — which is exactly why this decision has to be personal, not a blanket rule.

3. Plans Can Change Every Single Year

Unlike Medigap, Medicare Advantage carriers can change benefits, copays, and provider networks annually during the Annual Election Period.

A plan that looked great at enrollment can look different two or three years later.

Sometimes that's because the carrier redesigned it — sometimes because a hospital system and the insurer couldn't agree on a new contract.

One year, our office spent weeks helping hundreds of clients move because a major hospital system and an insurer couldn't reach a new contract. The phones rang constantly.

Most of those clients liked their plan. They just didn't want to lose their doctors.

That stretch stuck with me because it showed how quickly a network dispute between two companies becomes a patient's problem.

This is probably the part that saddens me the most.

By the time many people reach their late 70s or 80s, they finally have a healthcare routine they trust. They know their doctors, their specialists, and where they go for care.

Then a letter arrives saying their plan has changed or their providers are no longer in network.

Instead of focusing on their health, they're forced back into comparing Medicare plans, checking provider lists, and worrying about whether they'll be able to keep seeing the doctors they know.

Medicare is already complicated enough.

Watching older adults navigate that process all over again is difficult — especially when it's because of changes they had no control over.

Experiences like this are one of the biggest reasons I've become more cautious about recommending Medicare Advantage than I was 10 or 15 years ago.

Every September or October, Medicare Advantage members receive an Annual Notice of Change (ANOC).

I encourage every client to actually read it — that's where you'll find next year's copays, network changes, drug coverage shifts, and any changes to supplemental benefits.

The Phone Calls We Receive Most Often

Those three patterns show up clearly in the calls we get. Most people who call us after enrolling are calling because something changed — not because everything continued working exactly as expected.

Most call because something changed:

• "My doctor says they don't take my plan anymore."
• "I didn't realize the hospital stay had a daily copay."
• "I moved and my HMO isn't available here."
• "Can I switch to Medigap now?"
• "My prescription isn't covered anymore."

A doctor left the network. A medication moved to a different tier. A hospital contract ended. Or someone simply realized they wanted more flexibility than they thought they needed at 65.

Not All Medicare Advantage Plans Are the Same

It helps to separate three different things people lump together as "Medicare coverage":

• HMO: lowest cost, but you're generally limited to in-network doctors and need referrals for specialists
• PPO: more flexibility to see out-of-network providers, usually for a higher cost-share
• Original Medicare + Medigap: broadest provider access, standardized benefits, highest monthly premium

Beyond plan type, location matters more than most articles mention. A PPO in a major metro area isn't the same product as an HMO in a rural county.

One county may have excellent provider access with dozens of in-network specialists. The county next door might have only a handful.

That's not a detail Medicare.gov's plan finder makes obvious, but it shapes the entire experience of the plan.

If you pick a Medigap plan, the next decision is which plan letter. See our full comparison of Plan G vs. Plan N vs. High-Deductible Plan G for the details.

The Questions I Ask Every New Medicare Client

Before I recommend anything, I need to understand the person in front of me. When someone calls our office, these are usually the first things I ask.

• Do you travel, and how often?
• How many specialists do you see regularly?
• Could you comfortably absorb a $5,000–$9,000 medical bill in a single year?
• Are you okay reviewing your coverage every fall, in case something changes?
• How important is it to keep your current doctors?

Someone who travels often and wants to keep the same specialists for years tends to lean Medigap.

Someone who's local, budget-conscious, and comfortable reviewing their plan annually often does well with Medicare Advantage.

One question I often ask on top of those: are you choosing a plan for the person you are today, or the person you'll likely be ten years from now?

Health and priorities both tend to shift, and it's worth planning for that shift now rather than after it happens.

There's no universal right answer. There's only the answer that fits the person on the phone.

How the Medicare Advantage Market Changed in 2025 and 2026

This is the part of the story that doesn't get much coverage, and it's worth understanding as market history, not as a scare tactic.

Everything we've discussed so far has been about people choosing to leave. The 2025–2026 disruptions are a reminder that sometimes people don't have that choice.

Sources: PolicyGuide reporting linked above, plus KFF's 2026 Medicare Advantage Spotlight and plan-terminations analysis.

It wasn't only rural areas — some large urban counties saw exits too.

But it's a pattern I now watch closely with clients in smaller markets, since a plan's stability there can depend on how much local enrollment it has to support the network.

That reinforced something I'd already been noticing in my own practice — that Medicare Advantage requires more ongoing attention than many beneficiaries expect at 65.

It's one of the reasons I now pay much closer attention to where someone lives than I did ten years ago.

A strong Medicare Advantage market in a major metro area can look very different from the options available in a smaller county.

None of this means Medicare Advantage is disappearing.

It means the market is consolidating and carriers are being more selective about which counties and networks they'll support going forward.

For a closer look at how the 2026 shakeout is playing out by carrier, see our breakdown of 2026 Medicare Advantage winners and losers.

Looking ahead, our take on the proposed 2027 changes covers where this may be headed next.

I don't believe these events mean Medicare Advantage is "failing."

They do remind me that these plans are dynamic products that require ongoing review, while Medigap tends to be much more stable once you're enrolled.

Why Medigap Often Comes Out Ahead

Medigap usually costs more per month.

In exchange, it removes most of the moving parts that cause the calls described above.

(If you're still weighing whether supplemental coverage is worth it at all, see our full breakdown of that question.)

Benefits Are Set by Federal Standards

Medigap plan benefits are standardized by the government, so a carrier can't redesign what Plan G or Plan N covers from one year to the next.

Small costs can still shift — the Part B deductible that Plan G holders pay ($283 in 2026) tends to rise gradually, and Plan N's small office and ER copays can adjust too.

That's a much smaller amount of change than what an Advantage plan can revise annually.

No Network to Worry About

As long as a provider accepts Original Medicare, Medigap covers you there — no referrals, no network disputes between a hospital and an insurance company to get caught in the middle of.

Cost-Sharing Is Simple

Original Medicare pays roughly 80% of covered costs, and your Medigap plan generally covers the rest. There isn't a separate hospitalization copay to plan around.

One tradeoff worth naming honestly: Medigap doesn't include drug coverage, so you'll need a standalone Part D plan alongside it.

Medicare Advantage vs. Medigap, Side by Side

Neither column is universally "better" — the right one depends on how much you value predictability versus lower monthly cost and added perks.

For every Medigap plan letter side by side, see our full Medicare Supplement comparison chart.

If You Travel Frequently, I Pay Extra Attention

Travel habits change this decision more than almost anything else I ask about.

Every winter we hear from snowbirds who assumed their plan would work the same in Florida as it did back home. Sometimes it does. Sometimes it doesn't.

That's why I spend so much time asking about travel before recommending a plan.

Snowbirds who split time between two states often find an HMO frustrating, since routine care outside the home region typically isn't covered. A PPO helps, but usually at a higher out-of-network cost.

RV travelers and retirees who move around throughout the year run into the same problem, just more often.

Even having kids in another state matters — plenty of clients want the flexibility to see a specialist near a son or daughter, not just near home.

Medigap sidesteps all of this. If a provider accepts Original Medicare, you're covered, regardless of which state you're standing in.

See our full list of the best Medicare Supplement plans for frequent travelers if that's your situation.

Which path sounds like you? Here's a quick way to sound-check it before we go further.

How My Advice Has Changed Over the Last 15 Years

When I first became licensed, I recommended Medicare Advantage much more often than I do today. At the time, it was an easy recommendation for many healthy retirees.

Networks were broad, premiums were low, and comparing it to a $150–$200 Medigap premium wasn't always an easy conversation.

Between roughly 2015 and 2023, that gap only got harder to justify. Advantage plans added perks — dental, groceries, gym memberships — while standard Plan G premiums kept climbing.

In a lot of conversations, Medicare Advantage was genuinely the stronger pitch.

What shifted my thinking wasn't a single event.

It was years of annual reviews with existing clients, sitting through carrier training meetings, and fielding the panicked calls that come every time a network contract falls apart.

The 2025–2026 carrier pullbacks didn't create these concerns. They confirmed patterns I'd already been watching build for years.

I've also learned that the best Medicare decision usually isn't made by comparing brochures.

It's made by asking better questions about someone's health, finances, and how they actually use healthcare.

Today I start every conversation with an open mind. But unlike 10 or 15 years ago, Medicare Advantage now has to earn a "yes" from me instead of being the automatic starting point.

When You Can Actually Switch

Each year during the Annual Election Period (October 15 – December 7), you can move from Medicare Advantage to Medigap.

If you've had Medicare for more than 12 months, though, the Medigap carrier can ask health questions during underwriting, and approval isn't guaranteed.

(See our full answer to whether you can get a Medicare Supplement plan anytime.)

The best time to enroll in Medigap is during your Medigap Open Enrollment Period — the six months starting the month you turn 65 and enroll in Part B.

During this window, you have guaranteed-issue rights, meaning you can't be turned down for health reasons. (See Medicare.gov's official rules on buying a Medigap policy.)

Outside of that window, a Special Election Period may still apply — for example, if you move somewhere your HMO doesn't cover.

See our full breakdown of switching from Medicare Advantage to Medigap for the details that apply to your situation.

Bottom Line

Medicare Advantage isn't a bad product. It's simply designed differently than Original Medicare paired with Medigap.

After more than 15 years helping people compare the two, I've found that people who value flexibility, nationwide provider access, and predictable costs are usually happier with Medigap.

That's true as long as it fits their budget.

Medicare Advantage can still be an excellent choice for someone who prioritizes a lower monthly premium and is comfortable reviewing their coverage each year.

If someone asks me, "Which would you choose for your own parents?" my answer is usually Medigap — provided the premium comfortably fits their budget.

That recommendation isn't based on one news story or one bad experience.

It's based on what I've watched happen over more than 15 years helping Medicare beneficiaries before they enroll, and supporting them afterward.

One thing I've learned after all that time is there isn't a perfect Medicare plan — only the plan that best matches someone's priorities.

My job isn't to convince everyone to choose Medigap or Medicare Advantage. It's to make sure they understand the trade-offs before they enroll, because changing course later isn't always easy.

If you do land on Medigap, it's worth taking the time to research Medigap insurers properly before you buy — the plan letter is standardized, but the company behind it isn't.

That means understanding why some Medigap companies close blocks of business, since a stable carrier matters just as much as the plan letter you choose.

If you'd like to verify anything I've discussed here, I encourage you to review Medicare.gov's official resources on Medicare Advantage, Medigap, and the Annual Notice of Change.

Understanding the trade-offs for yourself leads to better decisions than simply taking anyone's word for it — including mine.