Choosing the right Medicare plan is essential for ensuring you have the coverage that best meets your health care and financial needs. However, as your health, budget and provider networks change, your current plan may no longer be the best fit.
Whether you’re facing rising costs, changing medical needs or a plan that no longer covers your prescription or doctors, it may be time to consider switching. Medicare offers several opportunities to change plans. Understanding when and how to switch can help you avoid unexpected expenses and ensure you receive the best possible care.
[READ: 7 Reasons to Switch Medicare Part D Plans]
When Should You Change Your Medicare Plan?
You should consider switching your Medicare plan if your health care needs or financial situation have changed.
You may want to think about a change if you have:
— Changing health care needs. As your health evolves, if you need different doctors, specialists or medications, your current plan may no longer be the best choice.
— Changing plan benefits. Don’t assume your plan will always cover the same benefits that it did. Plans add or remove benefits from year to year, so don’t assume what you had before will stay the same. Before open enrollment, you’ll get a notice of these changes. Read it carefully to make sure you still have what you need.
— Cost increase. If your plan costs increase or your health care needs increase, it’s a good idea to review your options to see if a different plan offers similar or better coverage at a lower price. You might switch for a lower premium if your current one increased and you anticipate minimal health care needs. Or, if you’d rather pay more each month but have your plan cover more right away, look for a plan with a low or $0 deductible.
— Prescription coverage. If your plan does not cover a new medication, has dropped coverage for your prescriptions or has significantly increased costs, it may be time to consider switching plans. Each year, plans update their formularies (covered drug lists), which may result in your medication being dropped, moved to a higher cost tier or requiring prior authorization.
— In-network providers. If your plan no longer includes your health care provider, you might want to switch. Remember that most Advantage plans also limit coverage to a certain geographic area, which may no longer work for you if you or your doctor have moved.
— Extra benefits. Medicare Advantage plans very often offer “extra” benefits not found in original Medicare. If you need medical benefits (such as dental, hearing and vision) or nonmedical benefits (such as gym memberships, caregiver support or transportation to medical appointments) consider switching.
If you are considering a change, find out what is in your area with Medicare’s online plan finder.
“Consumers should then call plans directly to confirm networks and drug pricing before enrolling. Plan finder information is not always accurate, and plan networks and drug prices can change over the course of a year,” advises Amanda Grady, lead benefit specialist and supervising attorney at the Elder Law and Advocacy Center of the Greater Wisconsin Agency on Aging Resources in Madison, Wisconsin.
[READ: How Do I Know When I’m Eligible for Medicare?]
When Can You Change Plans?
Understanding when you can switch your Medicare plan ensures you always have the best coverage for your health and financial situation. Here are three key enrollment periods to be aware of:
— Open enrollment period. The general open enrollment period is October 15th through December 7th with coverage beginning on January 1st. Also called the annual enrollment period, this is the time that anyone on Medicare can switch or add coverage, as well as ask questions.
— Medicare Advantage open enrollment period. You must already be enrolled in a Medicare Advantage plan to qualify for this enrollment period, which runs from January 1 through March 31. You can switch to another Advantage plan or return to original Medicare. You can also sign up for Part D drug coverage if you return to original Medicare.
— Special enrollment period. The special enrollment period can happen at any time of year with a qualifying event.
“Medicare beneficiaries can change their coverage if certain events happen that trigger a special enrollment period. This would include if someone changes their address, recently lived in a facility such as a nursing home, lost their current coverage, gained eligibility for other coverage, is dually eligible for Medicare and Medicaid or other exceptional circumstances,” says Gretchen Jacobson, vice president of the Medicare program for the Commonwealth Fund, a foundation focused on health care policy based in New York City.
[READ: What Is a Medicare Flex Card?]
Changing Medigap Plans
Changing Medigap plans can be a bit more complex than switching original Medicare or Advantage plans as some different rules apply. Use Medicare.gov’s online tool to see what options you may have.
The best time to sign up is during the one-time Medigap open enrollment period, which happens within the six months you turn 65 and sign up for Parts A and B as insurance companies cannot deny you coverage or charge you more due to pre-existing health conditions. Outside of this period an insurance company may use medical underwriting, which can lead to higher premiums or denial of coverage.
“There are some situations, however, outside of the open enrollment period where insurance companies cannot deny you a Medigap policy. These are called ‘guaranteed issue rights,'” Grady says, “For example, you have guaranteed issue rights if you lose Medigap through no fault of your own or you drop your Medigap plan to try a Medicare Advantage plan and decide to switch back within 12 months.”
Depending on your state you may have further rights.
“Some states provide additional periods where beneficiaries can purchase Medigap without underwriting,” Jacobson says, “They may specify these as Medigap open enrollment periods. As an example, Maryland provides an open enrollment period without underwriting during the 30 days following a Medigap policyholder’s birthday.”
How Can You Change Plans?
There are a few ways you can change plans. They include:
— Online. You can enroll online through Medicare.gov.
— Phone. Call 1-800-MEDICARE (1-800-633-4227).
— Plan’s website. Often plans allow you to enroll or leave directly through their website.
— With a licensed insurance agent. A licensed insurance agent can help you compare plans and make the switch.
Bottom Line
People may choose to change their Medicare plan if their health care needs, costs or coverage options have changed. Common reasons include rising premiums, changes in prescription drug coverage, losing access to preferred doctors or needing additional benefits.
Plan changes are limited to specific enrollment periods throughout the year, but a special enrollment period may be available under certain circumstances. Medigap plans may be changed outside of enrollment periods, but depending on the circumstances, there is no guarantee of coverage. There are a number of ways to change your plan if you decide to change plans.
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When and How to Change Your Medicare Plan originally appeared on usnews.com
