From Fortune:

Richard Timmins went to a free informational seminar and signed up for a Premera Blue Cross Medicare Advantage plan after the agent touted cheaper costs and broader coverage. Now, at 76, Timmins is trapped in the plan, struggling to find care for his malignant melanoma as Medicare Advantage enrollees face restrictions on doctors and coverage.

Medicare Advantage plans have drawn in over half of all eligible individuals 65 and older with their low premiums and added benefits. However, many enrollees struggle to obtain care when they need it most, leading to concerns about the misleading coverage claims and aggressive sales tactics used by private insurance companies.

David Meyers, an assistant professor of health services, policy, and practice at Brown University School of Public Health, found that about 50% of Medicare Advantage enrollees left their plans within five years, with the majority switching to another Medicare Advantage plan instead of traditional Medicare. This could potentially indicate dissatisfaction with Medicare Advantage.

Enrollees like Timmins find it difficult to switch back to traditional Medicare due to cost and lack of availability of supplemental insurance. Medigap insurers can deny coverage or base their prices on medical history, making it challenging for beneficiaries who want to transfer from Medicare Advantage plans.

The federal government offers specific enrollment periods every year for switching plans from Medicare Advantage to traditional Medicare. But for Timmins and others like him, the ability to switch has been limited by the difficulty of obtaining Medigap coverage or the higher costs associated with it.

Timmins, who finished immunotherapy, doesn’t believe he would be approved for a Medigap policy due to his health issue, and if he did, it would likely be too expensive. For now, he remains with his Medicare Advantage plan, despite the challenges he faces in finding care.



Read more: Older Americans say they feel trapped in Medicare Advantage plans