When Can We Switch Medicare Advantage Plans?
If you want to enroll in, withdraw from, or switch your enrollment in a Medicare Advantage (Medicare Part C) plan, you're allowed to do so -- without any restrictions from the insurance companies based on your age or health history -- during what's called "open enrollment." When you have open enrollment depends on what you want your next coverage to be.
Switch from one Medicare Advantage Plan to Another
To switch from one Medicare Advantage plan to another, the open enrollment period runs from October 15 to December 7, 2012, for coverage in 2013.
Leave Medicare Advantage for Medicare Part A and Part B
To withdraw from a Medicare Advantage plan and return to traditional Medicare Part A and Part B, you may do so from January 1 to February 14, 2013. If you do, and your Medicare Advantage plan covered prescription drugs, during the same period you may also enroll in a Medicare Part D prescription drug plan.
Make Sure Your Prescription Drugs Are Covered
If the Medicare Advantage plan you're leaving included prescription drug coverage and you decide to switch to a Medicare Advantage plan that doesn't include drug coverage, you'll want to think about whether you still need help paying for prescription drugs. One option to consider is Medicare Part D -- a prescription drug plan. Medicare Part D is designed to help you cover your prescription drug costs. You can enroll in Medicare Part D at the same time you switch your Medicare Advantage plan. Open enrollment for Medicare Part D drug plans is also October 15 to December 7.
Decide Whether You Need Supplemental Coverage
When you're in a Medicare Advantage Plan, you don't need a Medigap Policy. But if you're leaving a Medicare Advantage Plan to go back to traditional Medicare Part A and Part B, you'll want to consider whether you should add a Medigap Policy. A Medigap Policy helps cover costs that aren't covered by Medicare Part A and Medicare Part B. Getting a medigap policy when you first turn 65 is pretty straightforward. Getting one a few years later, as you're switching out of a Medicare Advantage plan, can be more tricky. Unless you're protected by a "guaranteed issue right," your Medigap choices might be limited. The insurance company might require you to take a medical exam and might customize what it offers you (and what it charges you) based on your current health status.
When Open Enrollment Might Not Apply to You
Are you a new Medicare enrollee? If so, you can enroll in any Medicare Advantage plan offered where you live, any time within the three months immediately after the month in which you first sign up for Medicare.
Is your Medicare Advantage plan dropping you? If your Medicare Advantage plan drops out of your specific geographic area, you can join another Medicare Advantage plan operating where you live from October 1 to December 31. Or you can return to traditional Medicare Part A and Medicare Part B instead. If you do return to traditional Medicare, you're also guaranteed the right to buy a Medigap supplemental insurance policy. There are limited circumstances under which you can enroll in a Medigap or supplement policy with a guaranteed issue right after participating in a Medicare Advantage plan for more than a year. This is one of those opportunities.
Have you moved? A Medicare Advantage plan will not continue to cover you if you move out of its specific geographic service area. If you move out of your current plan's service area, you can enroll in any Medicare Advantage plan that operates in your new location. This is another one of the limited circumstances under which you can enroll in a Medigap or supplement policy with a guaranteed issue right after participating in a Medicare Advantage plan for more than a year.
To learn more about special enrollment for different parts of Medicare, see Medicare's official online pamphlet, Understanding Medicare Enrollment Periods. To learn more about Medigap policies that may be available to you, see Medicare's official online guide, Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare.
Why You Might Want to Switch Medicare Advantage (Medicare Part C) Plans
There are several reasons why you might need or want to switch your Medicare Advantage plan:
Your providers are no longer in network. Medicare Advantage plans fully pay -- and in many cases pay anything at all -- only for services provided by doctors, hospitals, and other healthcare providers that participate in that plan (known as being part of the plan's "network"). But networks change each year. If your regular doctors, hospital, or other providers won't be in your Medicare Advantage plan's network any longer, you may want to switch to a plan that does include them.
Your drug coverage changes. Every October, Medicare Advantage plans that include drug coverage may change the drugs they'll cover (the "formulary") for the following year. Or they'll change the conditions you'll have to meet to get coverage for certain drugs. If coverage by your current Medicare Advantage plan will change for the worse for one or more of the drugs you regularly take, you may want to switch to another plan with better coverage.
Your costs go up. Each year, Medicare Advantage plans may increase their monthly premiums, along with their deductibles and co-payments, for specific types of treatment or drugs. If such changes will make your out-of-pocket costs go up substantially, you may want to consider changing plans.
Your benefits are reduced. All Medicare Advantage plans must cover all medical care that traditional Medicare Part A and Part B cover. But many plans offer expanded coverage as part of their attempt to attract customers. Year by year, however, Medicare Advantage plans change these extra benefits. If you joined a plan in part because of an extra benefit that's now being cut, you may want to consider other plans that provide that benefit.
How to Choose a Medicare Advantage (Medicare Part C) Plan and What to Consider
Medicare Advantage plans vary from one state to another, and the number of plans available to you depends on where you live. To find out what plans are available to you, go to Medicare's official website online service, called the Medicare Plan Finder. It can provide you with a list and contact information for all Medicare Advantage plans sold where you live.
To make your decision, you'll want to follow these steps:
Step 1: See if your regular providers are in the plan's network. Make a list of the doctors, hospitals, and other healthcare providers you regularly see, then compare it to the Medicare Advantage plan's list of its network providers (its roster of participating doctors, hospitals, and so on). You can usually find the list of providers on the plan's website, or call the plan directly and ask them to send the list to you. Most Medicare Advantage plans pay little or nothing for care received from a provider that's not in the plan's network. If some of your regular providers are not in a plan's network and you want to stay with those providers, then that plan's no good for you. Ask your providers for their recommendations; they may have important experience and advice to share.
Step 2: Find out about payment for providers outside the network. Some Medicare Advantage plans pay at least a portion of medical bills from a provider who's not in the plan's network. So even if your primary care doctor is in the plan's network, this outside-network coverage may be important if it turns out that you need to see specialists during the coming year, especially if the plan network doesn't include a big roster of specialist providers near you.
Step 3: See if your drugs are covered. If your current Medicare Advantage plan covers your prescription drugs and you're considering switching to another Medicare Advantage plan with drug coverage, you need to find out whether the prescription medicines you regularly take are in the plan's formulary, or list of covered drugs. Each Medicare Advantage plan with drug coverage includes some but not all prescription medicines, and a plan pays nothing for drugs that aren't in its formulary. You can check a plan's formulary initially by going to the Medicare website's Formulary Finder, which lists each plan's covered drugs. Before enrolling in a plan, however, check with the plan directly to see if it places any restrictions on coverage of the drugs you regularly take.
Step 4: Learn if the plan covers services beyond Medicare. Most Medicare Advantage plans offer coverage of at least some medical care not covered by traditional Medicare, such as eye exams and glasses, hearing tests and aids, chiropractic, or dental care. These extras may make one Medicare Advantage plan more attractive than another.
Step 5: Find out about coverage away from home. All Medicare Advantage plans must cover emergency care while you're anywhere in the United States. But there's no requirement that a plan cover nonurgent care when you're outside the plan's service area, or any care (even emergency) outside the country. If you regularly spend time away from home, and particularly if you're out of the country, see what coverage a Medicare Advantage plan would offer while you're away.
Step 6: Compare cost and coverage with traditional Medicare plus Medigap.* This comparison should be done at your initial enrollment period. It's critical to look at the full impact of your decision, not just at the cost of premiums. Ask your medical providers lots of questions about their experience with different plans. Review coverage with a look at the future and possible need for care for Alzheimer's, medication misuse, rehabilitation after falls, and other issues of aging. Before you enroll in a Medicare Advantage plan, it's worth comparing that plan against traditional Medicare plus a Medigap supplemental insurance policy. You can find the Medigap policies for sale where you live by using the Medicare website's Medigap Policy Search tool. You should compare not only the premiums for the Medicare Advantage plan versus the premiums for any Medigap plan you consider but also the Medicare Advantage plan's deductibles and co-payments for doctor's visits and hospital care versus those with traditional Medicare Part A and Part B plus Medigap. Also factor in the importance to you of any extra benefits the Medicare Advantage plan offers that aren't covered by traditional Medicare (and thus not covered by a Medigap policy, either). This decision is not only important for now but also for your future.