Many people choose Medicare Advantage plans without exploring their options or noticing what changes their plan may have made, according to research by KFF, a health policy nonprofit. But now that a new year has begun, you may find that the plan you chose during fall Medicare open enrollment isn’t working for you. Or maybe you stuck with your old plan and it changed this year. (This can happen too.)
Medicare Advantage Open Enrollment, which runs from January 1 to March 31, gives members the option to switch Medicare Advantage plans or return to Original Medicare.
“It’s set up especially for people who start the year enrolled in a Medicare Advantage plan and allows them to make certain changes,” says David Lipschutz, associate director of the Center for Medicare Advocacy.
This is where to start.
IS YOUR CURRENT COVERAGE WORKING FOR YOU?
Even if you haven’t had a chance to test your stress plan yet, do some research while you still have time to change your mind. Are there providers or specialists you want to see or hospitals you prefer? Make sure they are on your network.
Check your medications, especially if you’re taking a newer drug that may be covered differently by different plans. How much do your prescriptions cost under your plan?
Next, consider your lifestyle. Traveling or planning to spend part of the year in another state? Make sure your insurance offers an extended network or a travel benefit. Or consider Original Medicare, which lets you see any doctor in the country who accepts Medicare.
WHAT CAN YOU DO DURING MEDICARE ADVANTAGE OPEN ENROLLMENT?
During this time, people who are already enrolled in a Medicare Advantage plan can switch one-time to another Medicare Advantage plan, or they can switch back to Original Medicare and buy a Medicare Part D prescription drug plan . But if you don’t already have Medicare Advantage, you can’t join a plan now.
That said, while you can go back to Original Medicare, you may not be able to sign up for Medicare Supplemental Insurance or Medigap. Medigap’s open enrollment period, when insurance companies must offer you a plan at the same price as everyone else, regardless of health problems, lasts for six months after you turn 65 and have Medicare Part B . After that, except in some states and situations, you will be subject to a medical subscription to qualify.
“While you can move in and out of a Medicare Advantage plan annually, your rights to purchase a Medigap policy are usually much more restrictive,” says Lipschutz.
NEED TO CHANGE PLAN?
Certain circumstances are red flags, meaning you should probably change your coverage. If your primary care doctor or hospital system isn’t out-of-network, for example, you’ll want to look for a plan that includes them.
If you’ve had a health event and found you weren’t covered the way you expected, consider switching plans, but keep in mind that the money you’ve paid is a sunk cost. You’ve already spent it, says Gang. And it may not make sense to start over in a new plan with a new deductible.
In general, resist switching plans just for the benefits. “We’re not in favor of chasing benefits unless everything else lines up right for the member,” says Fong.
Then next year, do your homework during fall Medicare Open Enrollment from October 15th to December 7th. “Ideally, you should go over the details of the plan in advance to avoid any surprises,” says Gang.
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