When it comes to healthcare, there’s no crystal ball that can help you predict your needs in the future (it would be nice if there were, wouldn’t it?). Your healthcare situation today may change drastically tomorrow. One day, you’re fit as a fiddle, sailing through retirement with ease. The next day, you find yourself with half a dozen medications and bimonthly trips to your family doctor. Life moves fast, and your health insurance should move with it. Fortunately, you’re not stuck with the same health plan from year to year, even if you have Medicare. Need to change your Medicare coverage? Here’s what you need to know.
(Not that these tips are for people who already have Medicare. If you’re new to the program, check out our other articles, like this one, for enrolling.)
Can You Change Your Medicare Plan (& How)?
Short answer: Yes. You can change your Medicare or Prescription Drug Plan by doing one of three things:
- Call Medicare directly (800) MEDICARE (633-4227); you may also want to visit your local Social Security Administration (SSA) office for more information.
- Call or write to the insurance plan you want to switch to.
- Enroll in another plan during the annual enrollment period. The annual enrollment period starts on October 15 and ends on December 7 each year. Coverage for your new plan will start on January 1.
Switching from Medicare Advantage back to Original Medicare
You can switch from your current Medicare Advantage plan back to original Medicare in one of three ways:
- If you’ve just enrolled in Medicare Advantage and aren’t happy with it, you have three months to change back to original Medicare. This is a special “test run” period available to new MA subscribers.
- If you’ve had your MA plan for longer than three months but want to switch back to Original anyway, you’ll need to wait until the Medicare Advantage Open Enrollment period (January 1 through March 31) or the Medicare Open Enrollment period (October 15 through December 7). In either period, you’re free to drop your MA plan in favor of Original Medicare.
Before you switch, though, think about your healthcare needs and why you want to switch. If Original Medicare works better for you, that’s fine. But MA plans have come a long way and cover a lot of services (especially ones that original doesn’t), so weigh your healthcare needs and budget carefully before dropping MA coverage. There may be a better MA plan for you instead, and you can switch to one during the same enrollment periods outlined above.
Switching from Original Medicare to a Medicare Advantage Plan
Do you presently have an Original Medicare plan (which includes Part A and Part B) and want to switch to a Medicare Advantage (Medicare Part C) plan? If so, you can do so during the Medicare open enrollment period, which lasts from October 15 to December 7 of each year.
You can sign up for a Medicare Advantage plan with one of the following methods:
- Through the insurance provider directly
- Through a licensed insurance broker or other online resource, like this website, to help you pick the appropriate policy
Note that you cannot enroll in a Medicare Advantage plan using a state or federal marketplace (like HealthCare.gov). These sites do not sell Medicare plans.
Switching from One Medicare Advantage Plan to Another Medicare Advantage Plan
You may be presently enrolled in a Medicare Advantage plan with a private health insurance company and want to switch to a different plan or a different provider. Or, you may want to add, drop or switch to a different Part D prescription drug plan. You can do so during the Medicare Open Enrollment Period, which lasts from October 15 to December 7 of each year.
You can also use the Medicare Advantage Open Enrollment Period that we mentioned earlier (January 1 to March 31) to switch from one Medicare Advantage plan to another. But unlike the OEP for everyone with Medicare, this signup window is only for people with a current MA plan in place. And you can only make a one-time change during the 3-month window. So consider your options carefully during this time.
Reasons you may want to switch
There are several reasons you may want to make a change in your Medicare plans. As mentioned before, a change in your medical situation may warrant a different type of coverage. Additionally, you may want to change your Medicare plan if the policy you did have, which once suited your healthcare coverage needs, changed. A change in your financial situation may also require you to change your Medicare plan.
Medicare insurance industry changes
The healthcare marketplace is a very fluid environment, especially today with the inception of Obamacare (also known as the Affordable Care Act, or ACA). We also have to take into account the ensuing additional changes planned by both the ACA and the Centers for Medicare & Medicaid Services (CMS), which manages the Medicare program.
The ACA mandates that every American have health coverage, and this includes people who are eligible for Medicare. If a person chooses not to sign up for original Medicare, to comply with the law, they must have insurance through: their employer, their spouse’s employer, a private health plan or a Medicare Advantage plan.
The ACA warns that a Medicare Plan B alone is not sufficient coverage to comply with the law; however Medicare Part A alone is sufficient. In addition, the ACA includes changes to Medicare-related policies that regulate insurance companies and different aspects of Medicare’s benefits.
An insurer changes its policies
Furthermore, it is expected that plans, coverage areas and costs will vary, adapt and change from year to year, as the more competitive insurance marketplace environment hopefully comes to fruition. As the ACA moves towards full implementation, you may need and want to change policies for a better, more competitively priced plan.
Some people are already seeing a changing landscape of insurance premium coverage and pricing due to the ACA’s new regulations and requirements. Comparing your plan each year is the best way to be certain you are getting the best possible coverage.
Your healthcare needs change
Obviously, it is reasonable to believe that your healthcare needs are likely to change over the years, too. This may be due to a change in the status of your health, which may make it possible to switch to a plan with less or more coverage or financial parameters than you currently have.
Prescription drug coverage change
Another reason may be as simple as a need for changes in your prescription drug coverage. Insurance companies offer different prescription drug plans that cover certain medications on one plan, but not on the others. These companies also frequently change which ones they offer under particular plans.
If you are taking certain medications, be sure to monitor your prescription drug coverage carefully each year and compare cost and coverage with original Medicare Part D, as mentioned above. Your prescription drug plan may have made changes. Or, your medications are no longer covered or the cost has risen too much for your budget. Regardless, you may want to switch plans or return to Medicare Part D.
Other situational reasons might be that you were not taking any medication when you enrolled in Medicare and opted for minimal prescription drug coverage, but now find that coverage inadequate. Or, perhaps you may need to make a change in plans because the medications you currently are taking are no longer covered under your plan.
It could also be that you are now required to take a new medication that’s not covered by your plan for a short span of time (a prescribed number of years’ drug therapy). Or, you may begin taking a medication or medications for which you may be required to take for the rest of your life, but are not covered by your current plan.
At the end of the day, the reason you may want or need to change your prescription drug plan isn’t that important. No, it’s the fact that you have the ability to switch without fear of penalty that really matters.
Finding or switching to the prescription drug plan that’s right for your needs today is the key to better health and maintenance. There are many options to help get you there and to consider. There are assistance programs, as well as resource tools to help you compare medications and plan coverage available to you. Should you wish to switch your prescription drug coverage, your options include:
- Medicare Part D (prescription drug plans)
- Advantage Plans (health and prescription drug plans)
Medicare Plan Finder – This is a federal government assistance tool. You can find and compare Original Medicare coverage to Medicare health, prescription and drug plans and Medigap plans. Go to: https://www.medicare.gov/find-a-plan/.
Again, if you’re considering enrolling in Original Medicare, you may want to visit your local SSA office for more information.
Or, if you’re interested in purchasing a Medicare Advantage, Part D or a Supplement plan, we invite you to shop with us, at HealthNetwork.com.