Open Enrollment Begins Oct. 15: Avoid These 5 Medicare Plan Problems

Why do people leave their Medicare plans? Surveys from the Centers for Medicare & Medicaid Services (CMS) offer nearly 30 different reasons from five major categories. I pulled together five years of survey data to analyze trends across nearly 100 companies offering Medicare Advantage and/or Part D prescription drug plans.

Here’s what I learned about the most common problems and how you can avoid them when you shop during open enrollment this fall. These are listed in order of the most commonly cited reasons for leaving Medicare Advantage plans.

1. Premiums, copays and other costs

Cost was the most common reason people left both Medicare Advantage and Medicare Part D plans. For example, their premiums or copays went up, they found a cheaper plan or they could no longer afford the plan.

About 21% of people leaving Medicare Advantage surveyed said they left because of financial problems with the plan. For Part D plans, it was considerably more: about 43%.

How to avoid cost problems: Take a careful look at the whole range of Medicare costs when comparing plans.

Start with premiums. For example, NerdWallet’s analysis shows that about 72% of Medicare Advantage plans have $0 premiums for 2027. It wouldn’t hurt to start by looking at those plans — but don’t stop there.

In addition to premiums, take a careful look at what you'd pay for primary care, specialist visits, hospitalizations and prescription drugs. These out-of-pocket costs might more meaningfully affect what you spend on healthcare.

For example, for a seven-day hospital stay, among the companies in NerdWallet’s 2027 analysis, Medicare Advantage companies’ average out-of-pocket costs range from about $225 up to $2,400. If you think you might spend some time in the hospital, choosing a plan with lower hospital copays could make a huge difference.

2. Doctor and hospital networks

About 19% of people surveyed said they left their Medicare Advantage plans because of problems with networks. That meant, for example, that their doctors, hospitals and/or clinics weren’t covered by the plan. This category doesn’t apply to Medicare Part D plans.

How to avoid network problems: Check plans’ networks before you sign up. Many insurance companies’ online plan finding tools allow you to enter your doctors and hospitals to show whether they’re covered. You might also want to look at preferred provider organization (PPO) or private fee-for-service (PFFS) plans, which can offer more flexibility to see out-of-network providers compared to health maintenance organization (HMO) plans.

3. Difficulty getting care

About 15% of survey respondents said they left their Medicare Advantage plans because of problems getting needed care, coverage and cost information. For example, they had problems with the approval process for care or getting the plan to pay for services. This category doesn’t apply to Medicare Part D plans.

How to avoid coverage problems: Look for plans that stand out for their customer service and member satisfaction. You can find these plans by checking reviews to find companies with lower complaint rates and stronger ratings for member experience.

If you run into denials when trying to get care, appeal the company’s decision. You’re pretty likely to succeed. About two-thirds of Medicare Advantage prior authorization denials (67%) were overturned on appeal in 2025, according to KFF, a health policy nonprofit.

4. Customer service

About 11% of people said they left their Medicare Advantage plans because of problems getting information and help from the plan. About 7% of people who left Part D plans said this was the reason. This category also includes people who were unhappy with customer service, or how the plan handled a question or complaint.

How to avoid customer service problems: Customer service and member experience scores in company reviews can be a good guide when choosing a plan.

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If you’re having trouble with your plan, free help is available from State Health Insurance Assistance Programs (SHIPs). SHIPs can provide unbiased help with Medicare issues such as billing questions and the appeals process at no cost. Find your state’s SHIP at shiphelp.org.

5. Prescription drug coverage

The smallest percentage of people leaving Medicare Advantage plans — about 9% — said they left because of problems with prescription drug benefits and coverage. For Medicare Part D plans, it was about 11%.

This category includes, for example, people who left their plans because of problems getting prescribed medications or getting the plan to pay for those medications.

How to avoid prescription drug problems: Before you sign up for a plan, confirm that your medications and pharmacies are covered at prices you can afford. The plan-finding tool on medicare.gov and many companies’ online tools can show what you’d pay for your medications at your chosen pharmacies.

Tips for open enrollment

People with Medicare Advantage or Medicare Part D prescription drug plans can shop around and switch plans every year during open enrollment. Medicare open enrollment runs from Oct. 15 through Dec. 7 each year.

If you’ve had problems with your plan, open enrollment offers a chance to pick a better one. And even if you’re happy with your current plan, it might change for next year, or you might find better coverage and/or lower prices elsewhere.

Consider these important factors when comparing plans:

• Coverage. Above all, your plan needs to cover the care you need. Look for plans that cover your doctors, hospitals and prescription drugs. If those aren’t covered, the other factors below won’t matter.
• Cost. Look at premiums, but also take into account out-of-pocket costs for medical care and prescription drugs. 
• Quality. CMS’ star ratings are a good guide to plans’ healthcare quality. Look for plans with higher scores on CMS’ 5-point scale.
• Customer service. Check out reviews of plans’ customer service and member satisfaction. For example, member satisfaction surveys from JD Power can offer a helpful look at which plans have happier customers.

Methodology

NerdWallet’s editorial team analyzed five years of Disenrollment Reasons files and annual enrollment data from the Centers for Medicare & Medicaid Services to find the most common reasons members give for leaving their Medicare plans.

Note: Percentages don't add up to 100% because respondents could select any number of survey options and not all people leaving plans do so because of a problem with the plan itself.

See our full methodology for more information.

The article Open Enrollment Begins Oct. 15: Avoid These 5 Medicare Plan Problems originally appeared on NerdWallet.