Open enrollment starts: 5 Medicare plan issues to watch for

Our analysis found the most common problems people report with their Medicare plans. Here’s how to handle them during open enrollment.

Why do people drop their Medicare plans? Surveys from the Centers for Medicare & Medicaid Services (CMS) list nearly 30 possible reasons across five broad categories. I reviewed five years of survey data to identify trends across nearly 100 companies offering Medicare Advantage and/or Part D prescription drug plans.

Here’s what stands out about the most common problems, along with ways to avoid them when you compare plans during open enrollment this fall. The items below are ranked by the reasons most often given for leaving Medicare Advantage plans.

1. Premiums, copays and other costs

Cost was the top reason people left both Medicare Advantage and Medicare Part D plans. In some cases, premiums or copays increased, a cheaper plan became available, or the person could no longer afford the coverage.

Roughly 21% of Medicare Advantage enrollees who left said money issues with the plan played a role. For Part D plans, the share was much higher at about 43%.

How to avoid cost problems: Compare the full range of Medicare expenses, not just the monthly premium.

Premiums are a good place to start. For instance, NerdWallet’s analysis shows that about 72% of Medicare Advantage plans have $0 premiums for 2027. Those plans may be worth a look, but don’t stop there.

Also review what you’d pay for primary care, specialist visits, hospital stays and prescription drugs. Those out-of-pocket expenses can have a bigger effect on your total healthcare spending.

For example, for a seven-day hospital stay, Medicare Advantage companies in NerdWallet’s 2027 analysis show average out-of-pocket costs ranging from about $225 to $2,400. If you expect to need hospital care, a plan with lower hospital copays could make a major difference.

2. Doctor and hospital networks

About 19% of surveyed people said they left Medicare Advantage plans because of network problems. That meant their doctors, hospitals and/or clinics were not covered by the plan. This issue does not apply to Medicare Part D plans.

How to avoid network problems: Check provider networks before enrolling. Many insurers’ online tools let you enter your doctors and hospitals to see whether they’re in network. You may also want to consider preferred provider organization (PPO) or private fee-for-service (PFFS) plans, which can offer more flexibility for out-of-network care than health maintenance organization (HMO) plans.

3. Difficulty getting care

About 15% of respondents said they left Medicare Advantage plans because they had trouble getting needed care, coverage details or cost information. For example, they ran into problems with approvals for care or getting the plan to pay for services. This category does not apply to Medicare Part D plans.

How to avoid coverage problems: Look for plans known for stronger customer service and higher member satisfaction. Reviews can help you find companies with fewer complaints and better ratings for member experience.

If a claim or request is denied, consider appealing the decision. Success is fairly common. According to KFF, a health policy nonprofit, about two-thirds of Medicare Advantage prior authorization denials, or 67%, were overturned on appeal in 2025.

4. Customer service

About 11% of people said they left Medicare Advantage plans because they had trouble getting information or help from the plan. About 7% of people leaving Part D plans cited the same reason. This category also includes people unhappy with customer service or with how the plan handled a question or complaint.

How to avoid customer service problems: Company reviews that include customer service and member experience scores can be a helpful guide when choosing a plan.

If you are struggling with your plan, free help is available through State Health Insurance Assistance Programs (SHIPs). SHIPs offer unbiased help with Medicare issues such as billing questions and the appeals process at no cost. You can find your state’s SHIP at shiphelp.org.

5. Prescription drug coverage

The smallest share of people leaving Medicare Advantage plans, about 9%, said prescription drug benefits or coverage problems were the reason. For Medicare Part D plans, the share was about 11%.

This includes people who left because they had trouble getting prescribed medications or getting the plan to pay for them.

How to avoid prescription drug problems: Before enrolling, make sure your medications and pharmacies are covered at prices you can afford. The plan-finding tool on medicare.gov and many insurers’ online tools can show what you would pay for your drugs 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.

If you have had problems with your current plan, open enrollment is a chance to move to a better one. And even if you are satisfied, your plan may change for next year, or you may find better coverage and/or lower prices elsewhere.

Keep these key factors in mind as you compare options:

• Coverage. First and foremost, your plan should cover the care you need. Look for plans that include your doctors, hospitals and prescription drugs. If those are not covered, the other factors below will not matter.
• Cost. Look at premiums, but also factor in out-of-pocket costs for medical care and prescription drugs.
• Quality. CMS star ratings are a useful measure of healthcare quality. Aim for plans with higher scores on the 5-point scale.
• Customer service. Review plans’ customer service and member satisfaction ratings. For example, JD Power member satisfaction surveys can offer a helpful sense of which plans have happier customers.

Methodology

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

Note: The percentages do not add up to 100% because respondents could choose more than one survey option, and not everyone who leaves a plan does so because of a problem with the plan itself.