The federal government offers two enrollment periods every year for switching plans. Right now, Medicare Advantage enrollees can switch plans or transfer to traditional Medicare during the open enrollment period ending March 31. You cannot, however, switch from original Medicare to a Medicare Advantage plan. That enrollment period pops up in the fall.

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Changing plans isn’t just for cranky consumers. It’s a common thing. About half of Medicare Advantage beneficiaries jumped ship from the Medicare Advantage program they initially enrolled in after five years, according to a study published in the JAMA Health Forum.

Most of those enrollees switched to another Medicare Advantage plan rather than traditional Medicare. Only a fraction, 15%, moved to the traditional Medicare program, according to the report.

“This was surprising to us because generally in the past we’ve thought that enrollment in Medicare Advantage plans was pretty sticky and that once you pick the plan, you kind of stay there forever,” David Meyers, an assistant professor at the Brown University School of Public Health and one of the researchers, told Yahoo Finance. “But there’s more movement within the program than previously realized.”

‘Restrictive’ plans

The researchers hypothesize that it largely has to do with access to healthcare providers.

“When you pick your plan, your provider network isn’t locked in with it,” Meyers said. “As people get older and develop more complicated health needs that require seeing a wider range of providers, or maybe a specialist that isn’t included in the initial network, they find the plan ends up being more restrictive than they had thought.”

I bring this up because I’ve been hearing from an increasing number of retirees on Medicare Advantage who feel trapped in their current plans.

The big reason they complain is just what Meyers mentioned — the angst when a specialist they’ve been referred to isn’t part of their Medicare Advantage plan network. The delay in getting the authorization is frustrating or simply doesn’t happen.

To push back on Medicare Advantage plans that make serious usage of prior authorization before approving care, the Department of Health and Human Services announced new rules that will require insurers to rule on prior authorization requests more quickly and to publicly report their performance. However, the change won’t officially start to take effect until 2026, so it doesn’t help those looking for a new plan today.

“When a doctor says a patient needs a procedure, it is essential that it happens in a timely manner,” HHS Secretary Xavier Becerra said in a news release. “Too many Americans are left in limbo, waiting for approval from their insurance company.”

This new timeframe for standard requests is expected to cut current decision timeframes in half, according to an HHS spokesperson. The rule also requires a specific reason for denying a prior authorization request, which will help streamline resubmission of the request or an appeal when needed.

Read more: HSA contribution limits for 2024: Here’s how much you can save

Plan administrators “have been stung by reports of behavior that puts their profits ahead of patient needs,” Philip Moeller, a Medicare and Social Security expert and principal author of the “Get What’s Yours” book series, told Yahoo Finance. “The new rules could increase the amount of care approved by Medicare Advantage plans — good news for patients but, in the short run at least, bad news for insurer profits and stock prices.”

These plans have “ridden a gravy train using big federal subsidies to underwrite popular features, including dental, hearing, and vision benefits – things that traditional Medicare is not allowed to cover,” Moeller said. “The plans also returned enormous profits to shareholders and generated rising complaints that they achieved these results in part by denying legitimate care, limiting access to care, and gaming the system to boost profits.”

Traditional Medicare obstacles

For those of you considering shifting to traditional Medicare, which has no restrictions on the doctors who care for you, that choice also comes with some caveats.

While traditional Medicare provides much more flexibility in how you tap into healthcare than Medicare Advantage plans, it does not have a maximum limit on what people have to spend out-of-pocket every year before the care is 100% covered.

Advantage plans, on the other hand, generally provide managed-care provider networks that may limit choices, but the plans come with a built-in cap on out-of-pocket costs.

“Traditional Medicare can be very expensive unless you are able to enroll in a Medigap or Medicare supplement plan,” Meyers said. Those add-ons help offset those costs.

Medigap policies are health insurance policies sold by private insurance companies that pay part or all of certain leftover costs after Medicare pays. They can cover outstanding deductibles, coinsurance, and copayments and may also cover healthcare costs that Medicare does not cover at all like medical care received when traveling out of the US.

Some traditional Medicare enrollees receive supplemental gap insurance as a retirement benefit from their former employers, and low-income seniors get help from Medicaid.

The problem for people looking to switch from Medicare Advantage to traditional Medicare is that in most states, the time to buy a Medigap policy is when you first sign up for Medicare Part B. That’s because Medicare does not permit Medigap plans from rejecting you or charging a higher premium, because of a pre-existing condition. Your premium, however, will vary depending on factors such as your age, gender, and where you live.

That policy is also good if you joined an Advantage plan during your first year of Medicare but disenrolled from it within a year and switched to traditional Medicare. After that, though, Medigap plans in most states can flat-out reject you if you have a pre-existing condition, such as diabetes. The exceptions are New York, Connecticut, Maine, and Massachusetts.

This table offers a detailed look at all the Medigap plan options. If you’re mulling moving back to traditional Medicare, you might start by contacting your State Health Insurance Assistance Program, or SHIP, for free counseling services to help you navigate the various offerings.

Enrollment in Medicare Advantage plans, which are funded largely by the government but administered by private insurance companies, has exploded in the past few decades. In 2023, 30.8 million people were enrolled in a Medicare Advantage plan, accounting for more than half of the eligible Medicare population, up from 19% in 2007, according to KFF’s analysis. It’s projected to grow to 60% over the next decade.

The average Medicare beneficiary has access to 43 Medicare Advantage plans in 2024 and is able to choose from plans offered by eight firms. UnitedHealthcare and Humana, however, accounted for nearly half of Medicare Advantage enrollment last year.

A big enticement of Medicare Advantage plans is that they typically include coverage for benefits not included in traditional Medicare, such as Medicare drug coverage (Part D), eyeglasses, dental coverage, and fitness classes. Plus, they often have very low or even no premiums.

But there could be higher costs ahead for these plans.

“Medicare Advantage plans are hurting for the first time since their popularity began surging,” Moeller said. “Consumers are using more healthcare, in part as a belated rebound from the decline in care during the pandemic.”

The upshot: This fall, when details of their 2025 offerings are revealed, there will be pressure on Medicare Advantage plans to implement a mix of higher consumer costs and cuts in their coverage of dental and other supplemental benefits, Moeller said.

“Prepare yourself for 2025 annual enrollment this fall. Read the documents that plans must provide you in September. Most importantly, look at changes in plan costs and coverage features.”

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