5 Reasons Why Clients Switch Medicare Plans and How to Retain Them

October 15th marked the start of Medicare’s Annual Enrollment Period (AEP) – a seven-week window when Medicare beneficiaries can enroll in or switch plans for the 2026 coverage year. AEP is an opportunity for enrollees to reassess their needs, explore better coverage options, and address changes in health, costs, and/or provider networks.

According to The Commonwealth Fund, about 15 percent of beneficiaries have switched coverage during AEP over the past two years. Medicare Advantage and Medicare prescription drug plans typically change from year to year and can significantly affect an individual’s access to care and overall costs. Yet, despite these changes, nearly 7 in 10 (69%) beneficiaries did not compare their coverage options during last year’s open enrollment period.

This year, it may be more important than ever for your clients to review their plan choices -especially as benefits, costs, and networks continue to evolve. Below, we’re breaking down five of the most common reasons clients switch plans during AEP and what you can do to help guide them through the process.

1. Their Doctor Is No Longer In-Network

As mentioned above, it is typical for carrier plans to experience changes from year to year. One potential change is that a doctor or specialist becomes out-of-network. This can happen due to contract or financial reasons. If your client wants to see their same PCP and/or specialist, they will need to switch to a plan that includes them as an in-network provider. Otherwise, they will have to pay out-of-pocket costs.

What you can do as their agent:

1. Verify the change – Start by confirming the change is permanent through the carrier’s provider lookup tool.
2. Review alternative plans – If your client wants to keep their doctor, check other plans in their area to see which ones still include that provider in-network.
3. Consider out-of-network benefits – Again, some plans still allow clients to see their chosen doctor, just at a higher cost. Help your client understand what this means so they can make the best decision.

2. Their Plan Costs Too Much/Costs Have Increased

A plan’s cost depends on many factors, like premiums, copays, deductibles, coinsurance, and even the cost of drugs (on Part D plans). Costs can change from year to year and become too high for individuals to pay.

Many clients don’t realize costs have increased until it’s too late, and they are pigeon-holed into expensive coverage. AEP is the perfect time to see if your client’s plan is financially a good fit, or whether another option may be better.

What you can do as their agent:

1. Review their ANOC to see exactly what costs have changed.
2. Compare current plan costs with new options – This will help you and the client determine which plans have the same benefits but at a lower cost.
3. Check eligibility for savings programs – Many clients qualify for savings programs that can lower premiums and copays.
4. Evaluate total cost of care – Educate your client that the lowest premium doesn’t always mean the lowest total cost. Help them determine the total expected spending for a plan.

3. Their Plan is Terminated

Every year, Medicare beneficiaries enrolled in Medicare Advantage and or Part D drug plans receive their Annual Notice of Change (ANOC), detailing changes to their plan costs and coverage. This year, some clients were surprised to see that their plan no longer exists, and were switched to a new one.

There are different reasons why a carrier’s plan might be terminated, and a client would be moved to a new plan. To avoid confusion and/or concerns, it’s best to contact your clients during AEP to discuss coverage options and which plan might be a better fit.

What you can do as their agent:

1. Explain what’s happening and reassure them that you will help them find the best replacement option.
2. Review their needs and preferences – They may have new health needs, financial constraints, or preferred doctors – this is a chance to update their plan needs/wants.
3. Compare new plan options – Help your client enroll in a new plan that has similar/improved benefits to their old plan.

4. Plan Benefits are Reduced

Sometimes, when plans change from year to year, they scale back their benefits and offerings. Some clients may choose a plan specifically for additional benefits, like fitness programs, dental, vision, and hearing services, and/or hearing aids, just to name a few.

AEP is a great time to review plans in their entirety with clients to ensure they are getting the most out of their chosen plan, or if they would like to change to a plan with additional benefits.

What you can do as their agent:

1. Review their ANOC to see exactly what benefits have changed.
2. Compare alternative plans – Use our quoting tool to compare plan options and find one with richer or better benefits.
3. Communicate Proactively – Don’t wait for clients to call you – reach out! Many don’t understand what benefit changes mean until it’s too late. Get ahead of the unwanted surprise!

5. Customer Service with Carriers has not met Expectations

Client dissatisfaction with their carrier plan is not uncommon. They may have had a bad experience with the carrier, or didn’t like the ANOC letter outlining their plan benefits. No matter what the situation is, it’s okay – your job is to help clients find the best coverage option for them.

You should let them explain why their plan didn’t meet expectations. It’s important to listen first, then make suggestions. Your role is to help clients find a plan they feel confident and secure in choosing.

What you can do as their agent:

1. Listen first and understand their experience – After they share their experience, ask open-ended questions to gain a deeper understanding of why the plan did not meet expectations.
2. Identify the root cause – Why are they upset? Did the doctor leave the network? Are prescriptions not covered? Are co-pays too high? This will help you find a plan with the right solution.
3. Explore coverage options together – If their dissatisfaction is significant, review other plans that fit their needs. Use our quoting tool to compare costs and benefits, and help them switch to a new plan.

Be the First Voice Your Clients Hear This AEP

Although clients may desire or even need to explore plans during AEP, it’s a good idea to be the first to connect. Open up the line of communication and make sure your clients hear from you before they hear from a competitor.

A few simple strategies can make all the difference:

• Encourage clients to save your name and number in their phone so they recognize your calls
• Reach out frequently with updates or check-ins
• Make sure they always know who to turn to when questions arise

By taking these steps, you’ll not only retain your clients but also strengthen your relationships. You will demonstrate your clients best interests are at the heart of what you do.