Medicare Advantage plans were intended to save money for taxpayers and to offer more flexible benefits to enrollees than Traditional Medicare. A win-win, if ever there was one. Perhaps not surprisingly, the plans have done neither as the insurance companies offering them have gamed the system to increase their profits. The taxpayers have been getting screwed as have the advantage plan participants.
Medicare Advantage plans often offer additional benefits not found in Traditional Medicare. This is a big selling point and is frequently cited by enrollees as the reason for their choice of a Medicare Advantage plan. However, as I have pointed out from time to time, there is no free lunch. In order to obtain these additional benefits, enrollees must agree to give up certain rights., Medicare Advantage enrollees may be required to participate in provider networks whereas enrollees in Traditional Medicare can go to any doctor they choose who will accept Medicare patients. Medicare Advantage enrollees may be required to obtain prior approval for many forms of treatment or to get a referral from a primary care physician before they are allowed to see a specialist. No such requirement exists in Traditional Medicare.
Now another disadvantage is rearing its ugly head: Forced Disenrollment. Forced disenrollment is what happens when an insurance company offering a Medicare Advantage plan finds that it is not as profitable as it had hoped and decides to shut the plan down either completely or only in some locations. There is nothing to stop companies from doing this but it can be extremely damaging for those enrollees who are being forced out of their plans. They must find another plan, if they can.
Until recently, forced disenrollments happened from time to time but were not much of a problem for most people. As recently as 2024, the rate of forced disenrollments among Medicare Advantage enrollees nationwide was only 1%. In 2025, however, it jumped to almost 7%. This year it was 10%. One in ten people in a Medicare Advantage plan found that their plan was closing or would not accept them for the coming year. The pain was not spread evenly across the country. Some places got hit much harder than others. For example, almost 93% of the Medicare Advantage enrollees in the state of Vermont lost their coverage. In six other states, Idaho, Wyoming, Maryland, North Dakota, South Dakota, and New Hampshire, almost 40% of the Medicare Advantage participants were forced to disenroll from their plans.
When a participant is forcibly disenrolled from his or her Medicare Advantage plan, there is always going to be some disruption to their medical care, even under the best of circumstances. The sicker the participant is, the greater the disruption is likely to be and the more difficult it will be for the participant to find an adequate replacement for the lost plan coverage.
In the first place, there may be only a few companies offering Medicare Advantage plans in the area where the participant lives. As you can see, almost all of the companies offering Medicare Advantage plans in the state of Vermont left the state. What plans there are may have benefits that are substantially less than the old plan. After all, the reason the old plan closed up shop was that it was not making enough money. Any company replacing the old company will probably need to trim benefits to increase the profit margin. In some areas, especially rural ones, there may be no Medicare Advantage plans offered at all.
The participant who is forcibly disenrolled may well lose his or her doctor or doctor network. Their doctor may not contract with whatever plan they are able to secure. The drugs approved by the new plan may not be the same ones the enrollee was taking under the old plan. Having to find a new doctor is never easy and is even more difficult the older and sicker the enrollee happens to be.
While it is true that someone who is forcibly disenrolled from a Medicare Advantage plan can always go back to Traditional Medicare, they may not be able to afford to do so. The reason is the Medicare Advantage Trap. I have written about it in the past. Traditional Medicare does not cover all medical expenses. Typically, Traditional Medicare participants purchase supplemental coverage. If you purchase this coverage when you first become eligible for Medicare, the company selling it cannot refuse you and cannot charge you a higher premium, if you have substantial health problems. This is not the case, if you are seeking to purchase supplemental coverage after being in a Medicare Advantage plan. If you are sick, as we often are as we get older, they can charge you a higher premium and you may not be able to afford it. You either have to find another Medicare Advantage plan that will take you or return to Traditional Medicare and be uninsured for the bills Medicare does not cover.
Once you start down the Medicare Advantage path, you may never be able to go back. You may find you are dissatisfied with the trade offs you made to get the advantage plan benefits. You may not like the doctors they force you to see. You may not like the prior approval process they force on you. You may even find yourself tossed out of your plan and with no other option available to you. So before you start down the Medicare Advantage path, make sure you do so with a clear understanding of the potential consequences.
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