If you’re on a Medicare Advantage plan, you likely chose it based on your preferred doctor’s participation in the network. Did you know that doctors can drop out anytime, but why are doctors leaving medicare advantage networks?
This can create a frustrating situation where you suddenly find yourself without access to your trusted provider. But why do doctors leave Medicare Advantage networks? Let’s break it down.
Why Doctors Are Dropping Medicare Advantage Plans
- Low Reimbursement Rates : Medicare Advantage plans often pay doctors less than traditional Medicare. When providers aren’t adequately compensated for services, they may decide to leave the network.
- Billing & Claim Denials: Recent studies show that Medicare Advantage claim denials have increased ninefold in the past five years. Many doctors struggle with these constant denials and delayed payments, making it harder to provide care.
- Excessive Paperwork & Red Tape: Doctors and nurses are spending more time fighting for treatment approvals than actually treating patients. The referral process, prior authorizations, and administrative hurdles make Medicare Advantage plans frustrating for providers.
- Insurance Companies Dictating Care : Many doctors feel that insurance companies, not medical professionals, are deciding what treatments are necessary. This interference often leads them to leave Medicare Advantage networks in favor of traditional Medicare.
What Happens If Your Doctor Leaves the Network?
If your doctor drops out of your Medicare Advantage plan, you may have to:
- Find a new in-network provider (even if it’s not your first choice)
- Travel farther for care
- Deal with delays due to new referrals and approvals
Unfortunately, you won’t have the option to switch plans until the next enrollment period, leaving you stuck with limited choices.
How to Protect Yourself
Many doctors now recommend Original Medicare with a Medicare Supplement (Medigap) because:
- You can visit any doctor or hospital that accepts Medicare—no networks required.
- Claims are processed electronically with no paperwork for you or your provider.
- Medicare Supplement plans provide predictable out-of-pocket costs, unlike Medicare Advantage.
The Bottom Line
Doctors are leaving Medicare Advantage networks due to low payments, excessive paperwork, and denied claims. If you value flexibility in choosing your provider, consider exploring Medicare Supplement plans for a hassle-free healthcare experience.
Need help reviewing your Medicare options? Contact us today!
