Medicare Advantage Plans come from Medicare-approved private insurance companies and offer the same coverage as Original Medicare, plus added benefits such as dental and vision insurance. Medicare Advantage Plans often offer prescription drug coverage as well.
Medicare Open Enrollment, which takes place from Oct. 15 to Dec. 7 each year, allows Medicare beneficiaries to switch from Original Medicare to a Medicare Advantage Plan. If you’re already in a Medicare Advantage Plan and want to change to a new one, the Medicare Advantage Open Enrollment period runs from Jan. 1 to March 31.
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Understanding Medicare Advantage Plans
Medicare Advantage Plans typically provide expanded coverage compared to Original Medicare, often at a low or no additional cost. Medicare Advantage Plan providers offer various plan types, such as:
- HMOs: Only cover enrollees who see in-network healthcare providers and may require referrals to see specialists
- PPOs: Provide more coverage when enrollees see in-network healthcare providers
- Private fee-for-service plans: Cover treatment from any health provider who accepts the plan’s payment terms
- SNPs: Focus on specialized healthcare for people with specific health needs
- HMO point-of-service plans: Cover some out-of-network services for higher copays
- Medical savings account plans: Combine Medicare-funded bank accounts with high-deductible health plans
1. Assess Your Current Plan
When determining whether to switch Medicare Advantage Plans during Open Enrollment, first evaluate your current plan to determine whether it will meet your needs for the upcoming coverage year. Ask yourself the following questions:
- Does my plan provide adequate medical coverage, considering my specific prescriptions, conditions, and other health needs? It’s also good to think about your upcoming medical needs. If you know you’ll have new needs, such as surgery or getting glasses, then you may need to switch plans for optimal coverage.
- Does my plan fit my budget regarding premium costs, copays, coinsurance, deductibles, and out-of-pocket max? To estimate your plan’s total annual cost, multiply your monthly premium by 12, add your yearly deductible, and estimate copays and coinsurance based on your anticipated health needs for the upcoming year.
- Does my plan allow me to seek care from the providers and the facilities I prefer? Some plans have narrow networks that limit where you can go for treatment.
If you answer “no” to any of the above questions, you might consider switching to a new Medicare Advantage Plan.
2. Research Alternative Plans
If you’ve determined that you’re ready to switch to a new Medicare Advantage Plan, it’s time to research your options. Medicare offers plan comparison services through a few different avenues:
- Medicare.gov/plan-compare: Visit this website, enter your ZIP code, and browse and compare plan options. You can log in to your personal Medicare account for more personalized results.
- 1-800-MEDICARE: Call this number to compare plan options over the phone.
- 1-877-486-2048: If you use a teletypewriter, call this number to compare plans.
For more help comparing Medicare Advantage Plans, look at the star ratings provided by the Centers for Medicare and Medicaid Services (CMS). CMS releases star ratings for Medicare Advantage and Part D plans each year to evaluate plan quality based on dozens of metrics.
3. Seek Professional Guidance
A health insurance professional can provide valuable insight as you evaluate your options for switching Medicare Advantage Plans. You can contact Medicare directly through one of the phone numbers provided above, or you can call individual insurance companies to speak with an agent or a broker.
Alternatively, the National Council on Aging (NCOA) works with licensed Medicare enrollment specialists who can provide personalized advice on Medicare Advantage Plan choices. It’s free to speak with a Medicare enrollment specialist through NCOA.
4. Enroll in Your New Plan
Once you’ve chosen a new Medicare Advantage Plan, it’s time to make the switch. You can do so in a few different ways:
- Over the phone: Call your chosen plan to ask about the steps to enroll. Alternatively, you can call 1-800-MEDICARE.
- Online: Visit your chosen plan’s website to see if it allows you to enroll online.
- With a paper form: All Medicare Advantage Plans must offer the option to join using a paper enrollment form. Contact your chosen plan to obtain the form, then fill it out and submit it.
Regardless of how you enroll in your new Medicare Advantage Plan, you should prepare to provide your Medicare number and your coverage start date for Medicare parts A and B.
Preparing for the Transition
If you switch from Original Medicare to a Medicare Advantage Plan during Medicare Open Enrollment, you can expect your new plan’s coverage to take effect starting on Jan. 1 of the following year.
If you’re switching between Medicare Advantage Plans during the Medicare Advantage Open Enrollment, your new coverage should start on the first of the month after you request to join your new plan.
As you wait for your new coverage to set in, make sure to do the following:
- Switch your Medicare drug coverage as needed. If you have a Medicare Part D plan and will no longer need it with your new Medicare Advantage Plan, make sure to drop your Part D plan during Medicare Open Enrollment. You may disenroll by contacting Medicare or your plan directly.
- If you’re switching from Original Medicare with a Medigap plan, consider disenrolling from your Medigap policy since Medigap does not pay for Medicare Advantage deductibles, copays, coinsurance, or premiums. Drop your Medigap plan by contacting the plan provider.
Secure Your Healthcare Future
As you explore the process of switching Medicare Advantage Plans, make sure to conduct thorough research and consider your options carefully as you take each step. It’s important to make informed choices when it comes to health insurance.
Also, keep Open Enrollment periods and deadlines in mind. If you’re switching from Original Medicare, you must do so during Medicare Open Enrollment. If you already have a Medicare Advantage Plan, you should make the switch during Medicare Advantage Open Enrollment.