What to Do When You Hate Your Medicare Plan
The Centers for Medicare and Medicaid Services projected earlier this fall that Medicare Advantage enrollment would jump to 22.6 million people in 2019, representing nearly 37 percent of the Medicare population (and an 11.5 percent bump from this year). A growing number of people are choosing the private option over traditional Medicare. You may be one of them. Advantage offers plenty of benefits and covers services that original Medicare doesn’t. Unfortunately, not everyone who signs up for Medicare Advantage ends up loving the coverage. If you find yourself stuck with a Medicare Advantage plan that you hate, you may have options for switching to different coverage. And since MA plans are sold via individual companies, you’re bound to find something that fits your needs better with a bit of digging.
Switch During the Annual Election Period
Every fall, there’s a Medicare open enrollment period, which you can use to make as many changes to your Medicare coverage as you wish. This period begins on October 15 and ends on December 7. During this open enrollment period, also known as the annual election period, one option is to sign up for a different Medicare Advantage plan. For example, you could look for a plan with a broader network or a lower premium, or one that covers the prescription drugs you take.
The Medicare annual enrollment period also provides an opportunity to go from Medicare Advantage back to original Medicare. Just keep in mind that after having been covered by Medicare Advantage for a period of time, you may no longer be eligible to add Medigap to your health insurance lineup, or you may have to pay higher premiums for it.
Make a Change During Medicare Advantage Open Enrollment
Medicare in 2019 is going to give you an additional opportunity to change your coverage during the first part of the calendar year. This new Medicare enrollment session will begin on January 1 and end on March 31. This new enrollment period was created specifically for people with Medicare Advantage plans. You can’t use it to go from original to Advantage, but you can drop Advantage altogether and return to original if you can’t find a private plan that you like.
The main benefit of this extra enrollment period is to switch between Medicare Advantage plans, which you can do once during the period. This is a good option if you like the idea of having a private plan but just don’t like your current plan.
Keep in mind that the Medicare Advantage open enrollment period is reserved for people with Medicare Advantage. If you want to buy Advantage but have original, you’ll have to wait until the fall open enrollment period to sign up.
Act Right Away – Meaning Don’t Procrastinate
If you’re new to Medicare, you’ll get a grace period for testing out your new Advantage plan. During the first three months of your Medicare coverage, you can drop your MA plan and return to original Medicare or switch to a different Medicare Advantage plan.
This is a one-time offer, and it’s only for brand new enrollees. In fact, only those who are just coming out of their initial enrollment period can take advantage of this three-month opportunity. If you delay Medicare enrollment until later, you won’t be able to take advantage of the trial period.
Search for a 5-star Medicare Advantage Plan
All Medicare Advantage and Part D drug plans are given a star rating by the Centers for Medicare and Medicaid Services, ranging from 1 (poor) to 5 (excellent). Very few Medicare Advantage plans earn 5-star status. But when you find one, you can drop your current coverage and enroll in the better plan.
Living in an area with a 5-star Medicare Advantage plan can be a valuable asset. You have the right to switch from your current MA plan to one of these plans at almost any point in the year. The window for switching to a 5-star plan is open from December 8 to November 30. You can make this change one time a year. If you live in an area with a 5-star Part D prescription drug plan, you can select it during the same enrollment window. Doing so will switch you from your MA plan to original Medicare.
Plans with 5-star ratings are indicated with a special symbol so you can see them. Not sure where to find that information? You can browse plans using Medicare’s Plan Finder tool on the Medicare website or talk to a Medicare specialist about 5-star plan options in your area.
Look into a Special Enrollment Period
Certain life changes can qualify you to make adjustments to your Medicare coverage in the middle of the year. If you already have an MA plan, the special enrollment period qualification that’s most likely to apply to you has to do with moving to a new place.
Medicare Advantage coverage varies by geographical region. When you move out of the service area for your plan, you won’t be able to keep it. You’ll have a short window of time in which you can choose a new MA plan or change to original Medicare.
Do Your Best with What You Have
You may find yourself stuck midyear with no available avenue for switching to different Medicare coverage. If you’re in that frustrating position, you don’t have much choice except to make the most of the plan that you do have.
First, get to know your network. Research your doctors, hospitals and other providers so you know what’s out there and who to talk to about your concerns. If you’re not a fan of your primary doctor, look for one with better recommendations. Ask friends and family for advice about their providers, and switch if you need to and there’s an alternative available.
If you feel that an out-of-network specialist will be the best fit for your healthcare needs, you can appeal to have the treatment covered. Don’t be surprised if the appeal gets denied, but it doesn’t hurt to ask just in case.
Some medical care must be performed as soon as possible, but other treatments may be able to wait. If holding off is an option, you may find that your best bet is to switch to a different plan during the annual election period. Once your new Medicare coverage goes into effect, you can pursue needed treatments.
Start Making Plans for Next Year
While you wait for the opportunity to switch your Medicare coverage, start strategizing about what you want to look for in a new plan. Consider:
- Star rating: The better plans receive at least 3.5 stars.
- Out-of-pocket costs: Look into how much you’ll be expected to pay in coinsurance, copays and deductibles, and check the cap on out-of-pocket expenses (an exclusive benefit of Advantage plans).
- Coverage: Note whether your regular doctor and hospital are covered, and consider whether your preferred specialists are in network.
- Drug formulary: For plans with prescription coverage, check whether your medications are included and if your preferred pharmacy falls in network.
- Vision and dental: If these services aren’t covered by your plan, you’ll have to pay out of pocket for them, so look for one that includes them if you need glasses or want coverage for regular dental care.
Assess what it is you don’t like about the plan you have now. Are your in-network providers too out of the way? Does the drug coverage not address your prescription needs? Are you having an issue with claims or the company itself, or you’re just not a fan of the customer service and care you’re receiving?
If you have any questions or concerns, feel free to call us toll free. A licensed medicare professional will be happy to assist you.