changing Medicare coverage

The Annual Enrollment Period & Changing Your Medicare Coverage

If you wish to make changes to your Medicare Advantage (sometimes referred to as a Medicare Part C plan) or Medicare Part D prescription drug plans, you can do so during the Annual Enrollment Period (AEP). AEP, which stands for the Annual Election Period, begins on October 15 and ends on December 7 every year. This blog post covers the changes you can make to your Medicare coverage during this enrollment period.

Switch to a Medicare Advantage Plan From Original Medicare

Many individuals choose to enroll in Original Medicare when they turn 65 and first become eligible during their Initial Enrollment Period. If you later decide to switch to a Medicare Advantage plan, you can sign up for one during the AEP. There are many reasons why you may want to switch to a Medicare Advantage plan.

For starters, health changes or life changes may lead you to need health care benefits that are not being covered under Original Medicare (Part A and Part B) but are covered in Medicare Advantage. These typically include dental, vision and hearing care as well as transportation and over-the-counter benefits.

Secondly, if you are enrolled in Original Medicare and do not have Part D prescription drug coverage, you can add it through a Part D or Part C plan. Usually, most Medicare Advantage plans include prescription drug coverage, which you may deem a necessary benefit depending on your situation.

Do not be concerned that changing to Medicare Advantage will reduce your medical benefits under Medicare Part A and B. Medicare Advantage plans are required to provide plans that have benefits equal to that of Original Medicare, but as discussed, can offer plans that include additional benefits above Original Medicare.

Change From One Medicare Advantage Plan to Another

Medicare Advantage plans each have additional benefits, and these benefits can change annually based on the discretion of the insurance provider. Similarly, your needs can also change and evolve over time, leading you to search for a plan that better meets your health care needs. If your current Medicare Advantage plan doesn’t offer the benefits you need, you should find one with all the benefits you are seeking.

Another factor to consider is the cost of your Medicare Advantage plan. While most Medicare Advantage plans charge little to zero premiums, you should weigh the other costs, such as percentage of coinsurance, annual deductibles and out-of-pocket limits. Sometimes your plan’s costs may not change, but you may discover other plans that offer better rates, prompting you to switch plans during the Annual Enrollment Period.

Every year we see changes and improvements to Medicare Advantage plans. Not only more plan options, but also lower premiums and increased benefits. When evaluating your options as you consider changing your coverage, it’s important you weigh three factors: care, costs and benefits.

Our health is our most important asset. Thus, you need to select a plan that will allow you to access the providers and care you need to maintain a healthy lifestyle. The second consideration in your plan choice is your finances. Identify a plan that will be within your monthly budget, while also providing protection against sudden health changes that can be costly. Additionally, pay close attention to cost changes within your Part D benefits of your Part C plan. Lastly, determine if the plans you’re considering offer ancillary benefits like vision, dental, hearing that provide a greater value when weighed against your current plan or benefits.

Taking a holistic approach to your Medicare benefits can help ensure you are on the right plan for your specific medical and financial needs.

Change From a Medicare Advantage Plan to Original Medicare Part A and Part B

You may decide to disenroll from a Medicare Advantage Plan and instead sign up for Original Medicare during AEP. One of the main reasons people change their Medicare Advantage plans is when their preferred physicians, hospitals and pharmacies are no longer within their network. Unlike Original Medicare, Medicare Advantage plans have network restrictions that offer covered care only under a specific network of providers. Since private health insurance companies offer Medicare Advantage plans, contract changes may occur and your preferred health provider may no longer participate in your network. If your doctor is no longer within your Medicare Advantage plan network, you may disenroll from your current Medicare Advantage plan during AEP and either enroll in Original Medicare or find another plan your providers participate in.

Join, Change, or Opt-out of Part D Prescription Drug Plans

The Annual Enrollment Period is also your chance to change your prescription drug coverage: either by enrolling in, changing or disenrolling from a Part D plan. Like with Medicare Advantage plans that include prescription drug coverage, Part D plans provide coverage for self-administered brand-name and generic prescription drugs. Each Part D plan has a formulary that lists the precise medications that are covered and which tier of coverage they fall under; this list is subject to change annually. As your health needs or current plan’s formulary changes, you may require coverage for certain prescription drugs. This may necessitate a change from one prescription drug plan to another, which is possible during the AEP. Additionally, you can completely opt-out of Medicare Part D prescription drug coverage and enroll in another form of creditable prescription drug coverage at this time.

Preparation is key to taking advantage of this opportunity to adjust your Medicare coverage to better fit your needs. Outside the Annual Enrollment Period and the Medicare Advantage Open Enrollment Period (January 1 – March 31 of every year), you can only make changes to your coverage through a Special Election Period (SEPs) if you experience extenuating circumstances that qualify you.

It’s important to read the annual notices sent out in September by your current Medicare plan to find out what changes, if any, are occurring to your plan benefits and/or costs. Review such documentation carefully, which will include Evidence of Coverage (EOC) and Annual Notice of Change (ANOC).

Now that you’re aware of the plan changes you can make during the Annual Enrollment Period, you can plan to evaluate your Medicare coverage annually to determine if your plan provides suitable benefits for your needs and situation. If you need to consult with a licensed Medicare agent to review your plan and learn more about potential options you’re interested in, Medicare Portal is here to offer the assistance and resources to do so. Contact us today to get started!

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