Choosing FFS Medicare after Enrolling in Medicare Advantage Plans

After doing some quick scanning of articles on the topic of Medicare Advantage plan disenrollment, I found many leave Medicare Advantage because of complex healthcare conditions. Either a change in health leading to such or an inability to get the care they need. Medicare Advantage plans notoriously deny care as a method to delay care and gain greater profitability. There is more to my explanation than what I have said.

Medicare Advantage Disenrollment Among Beneficiaries With Chronic Conditions, JAMA Network, Linda Burke, PhD

To the Editor A recently published Research Letter on Medicare Advantage (MA) disenrollment patterns1 is misleading about the harms of MA to vulnerable patients enrolled in MA, which is not Medicare but a private, for-profit insurance plan.2,3

The authors report “having multiple chronic conditions was not associated with switching between MA and FFS [fee for service] between 2010 and 2019.”1 This result assumes patients are free to switch from MA to Medicare plus a supplemental plan, also known as Medigap (called FFS by the authors) any time they desire. Having this freedom, so we are to believe, patients are choosing to stay with MA as they are satisfied with their plan.

In reality, after a short grace period, once patients are enrolled in an MA plan, generally a health maintenance organization, they almost certainly cannot transition to Medicare plus Medigap (FFS) once they discover the inadequacies of their MA. Only 4 states (New York, Connecticut, Massachusetts, and Maine) allow patients to purchase a Medigap plan without underwriting once enrolled in MA.2 Even in these states, patients need to wait for open enrollment. Those with multiple chronic conditions may be hard-pressed to complete the paperwork necessary to switch insurance plans.

Patients cannot be accurately said to “choose” MA, given that its advertising fails to disclose important facts, such as that once they are enrolled, it is difficult to get out. It is past time for organized medicine to report on what patients actually experience from their “coverage” under MA, with its limited networks, prior authorizations, frequent denials, and limits on in-patient hospital and rehabilitation care.2,3

Medicare Advantage benefits insurance companies, which make more money from MA than from any other insurance product.3 Some physicians’ groups and individual physicians are advocating for patients by raising their voices against MA,4,5 and I believe that JAMA should stand behind these efforts.

  1. Raver  E, Jung  J, Xu  WY.  Medicare Advantage disenrollment patterns among beneficiaries with multiple chronic conditions.   JAMA. 2023;330(2):185-187. doi:10.1001/jama.2023.10369

2. Span  P. Which to choose: Medicare or Medicare Advantage? New York Times. Published November 20, 2022. Accessed August 29, 2023.

3. Abelson  R, Sanger-Katz  M. “The cash monster was insatiable”: how insurers exploited Medicare for billions. New York Times. Published October 8, 2022. Accessed August 29, 2023.

4. Physicians for a National Health Program. CMS should terminate the Medicare Advantage Program: PNHP comments on CMS file code CMS-4203-NC: “Medicare Program; Request for Information on Medicare Advantage.” Published August 25, 2022. Accessed August 29, 2023.

5. Rosenthal  ER. Letter to the editor re: Biden plan to cut billions in Medicare fraud ignites a lobbying frenzy. New York Times. Published March 28, 2023. Accessed August 29, 2023.

A Reply by the authors1; Medicare Advantage Disenrollment Among Beneficiaries With Chronic Conditions—Reply, JAMA Network, Eli Raver; Jeah Jung; Wendy Y. Xu,