There may be many reasons why you’re unhappy with your current Medicare Advantage plan. The choice of physicians is too limited. The costs of prescription drugs are too high. Or maybe you plan on spending your winter in another state where physicians and hospitals are covered by your plan.
If you’re reading this before March 31, you’re in luck. Because the annual Medicare Advantage Open Enrollment Period, which begins on January 1 and ends at the end of March, gives you an opportunity to change your coverage.
This winter/spring period also allows people who didn’t initially enroll in Medicare Parts A and B during their initial enrollment period—which starts three months before the month of their 65th birthday and ends three months after—to sign up, although they may have to pay late enrollment penalties for missing this key deadline.
What can Medicare Advantage subscribers do during this timeframe?
There are two things you can do if you’re unhappy with your plan:
- Switch to another Medicare Advantage plan.
- Switch from Medicare Advantage to Traditional Medicare.
A Medicare refresher course
Before discussing the pros and cons of switching coverage, let’s start with a basic overview of Medicare:
- Medicare Part A covers some of the costs of inpatient hospital care; skilled nursing facility care; short-term inpatient care in a skilled nursing facility; hospital care; and short-term home health care. For most people, there’s no monthly premium.
- Medicare Part B covers some of the costs of services or supplies to diagnose or treat your medical condition; preventive services to detect and treat illness; ambulance services; medical equipment; outpatient treatment services; partial hospitalization; and limited outpatient prescription drugs. Monthly premiums for Medicare Part B in 2024 start at $174.70 Those with higher monthly income may pay higher premiums.
- Medicare Part D is supplemental insurance that covers some of the costs of prescription drugs not covered by Traditional Medicare. Medicare Part D plans are offered by private insurers. Monthly premiums vary.
- Medigap—also called Medigap Supplement Insurance—covers the cost of co-pays, deductibles and other expenses not covered by Traditional Medicare. Medigap coverage is provided by private health insurers. Monthly premiums can range from as little as $50 to more than $400 per month, depending on where you live and the level of coverage.
Medicare Advantage plans bundle all of this coverage into a single plan offered by a private insurance company. These plans cover some (but not all) medical and prescription drug costs not covered by Medicare. You’ll still pay monthly Medicare Part B premiums, but you may not have to pay additional premiums.
This often makes total monthly premiums for Medicare Advantage plans significantly lower than the combined monthly premiums of supplemental Medicare Part D and Medigap policies.
Why switch from Medicare Advantage to Traditional Medicare?
Despite the relative affordability of Medicare Advantage plans, there may be good reasons for transitioning to Traditional Medicare Parts A, B and D.
- You want the freedom to see any physician at any facility, wherever you are. There’s no such thing as “out of network” costs. As long as the provider accepts Medicare payments, you’ll have access to them.
- You want to make sure that some of your prescription drug costs are covered. The sheer variety of Medicare Part D insurance plans available makes it highly likely that you’ll find one that covers your prescriptions with reasonable out-of-pocket costs.
If you make the switch, you can also apply for a Medigap policy at any time. However, healthcare insurers have the right to deny you coverage or charge you higher premiums if you have a previous condition.
Why stick with Medicare Advantage?
The main advantages of these bundled options are cost and convenience. Many Medicare Advantage plans also cover some of the costs of dental care and hearing aids. Traditional Medicare doesn’t cover these expenses.
Should you switch or stay?
If you switch Medicare Advantage plan providers or move to Traditional Medicare during this winter/spring period, your coverage generally begins the first day of the month following your decision.
The good news is that your decision is never permanent. You can change your coverage once every year.
And if you don’t want to do it now (or you’re reading this after March 31), you can wait until Medicare’s special enrollment period, which starts on October 15 and ends on December 7.
During this period you can switch Medicare Advantage plan providers; move from Traditional Medicare to a Medicare Advantage plan; transition from Medicare Advantage to Traditional Medicare; or add, change or drop a Medicare Part D provider.
Understanding your options
If you’re thinking of varying your coverage it’s important to understand the pros and cons of any changes you're considering. Fortunately, help is available. Every state has a State Health Insurance Assistance Program (SHIP) where consultants are available to work one-on-one with you at no charge to help you understand and evaluate your available Medicare options. You can locate a SHIP counselor in your area by visiting the SHIP web site at https://www.shiphelp.org.
This article was authored by Dan Flanagan and Jeffrey Briskin. Dan is a financial advisor and Partner located at Canby Financial Advisors, 161 Worcester Road, Framingham, MA 01701. He offers securities and advisory services as an Investment Adviser Representative of Commonwealth Financial Network®, Member FINRA/SIPC, a Registered Investment Adviser. He can be reached at 508.598.1082 or email@example.com. Jeffrey Briskin is Director of Marketing at Canby Financial Advisors.
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