Are you having buyer’s remorse over the Medicare Advantage plan you chose during open enrollment last fall? That’s understandable. Choosing a Medicare plan can be a confusing process.
Thanks to new government rules, however, you may be able to make a change during the special Medicare Advantage Open Enrollment Period, which began January 1 and runs through March 31.
Previously, you could only switch from a Medicare Advantage plan back to Original Medicare during this special enrollment window.
But this year the government has loosened things up a bit. Now you can go back to Original Medicare or you can switch from one Medicare Advantage plan to another.
There are, of course, restrictions.
If you are signed up for Original Medicare, you cannot use this window to switch to a Medicare Advantage plan. To do that, you’ll have to wait until regular open enrollment next October.
And if you have Original Medicare with a Part D prescription drug plan, you may not switch from that Part D plan to another, even if you discover your prescription drug coverage doesn’t meet your needs.
This second chance is limited to Medicare Advantage enrollees, who may have just gone through the painstaking process of picking a plan during the regular end-of-the-year enrollment period. Even so, if you fit one of these four scenarios, you may want to make a change again.
You’re paying more for your prescription drugs
Medicare Advantage plans often include prescription drug coverage. Each plan has its own formulary, or list of prescription drugs that are covered fully or partially.
This formulary changes frequently, and you may find that a medicine you need is no longer covered. Or, you may find that getting coverage for your meds is more work than you expected when you chose the plan, says David Lipschutz, associate director of the Center for Medicare Advocacy.
“More Medicare Advantage insurers are requiring pre-authorization or the use of a cheaper drug first, which may be something you didn’t realize or read carefully when you signed up,” he says.
If another Medicare Advantage plan in your area covers the medicines you need with fewer restrictions, that’s a reason to make a change.
Your preferred doctor or hospital is now out-of-network
One of the most significant differences between Original Medicare and Medicare Advantage is access to health care providers.
With Medicare Part A and Part B, which cover hospitals and doctor visits respectively, you may seek treatment from any provider that takes Medicare. Medicare Advantage plans, on the other hand, contract with a network of doctors and hospitals to lower costs (savings that lets them offer additional benefits such as dental and vision care).
If you find that doctors and other health care providers you need or are comfortable with are no longer in your Medicare Advantage network, you could return to Original Medicare or switch to an Advantage plan with a network that includes your providers.
You want to get Medigap insurance while it’s still easy to qualify
If you signed up for Medicare for the first time within the past six months and you chose an Advantage plan, there’s another reason you might be tempted to change your mind now and go with original Medicare and a Medicare Supplement plan instead.
These supplemental policies, also known as Medigap, cover some of the out-of-pocket costs you incur with Original Medicare. But in all but four states, if you don’t sign up for a Medigap policy within six months of when your benefits kick in under Original Medicare, insurers can charge you substantially more or deny you coverage if you have a preexisting condition when you apply later.
To avoid that scenario, you can use the special enrollment period to reconsider Original Medicare with a supplement policy.
You want in on the new Medicare Advantage benefits
Government rules announced last year allow Medicare Advantage plans to provide new services, including adult daycare, home-based palliative care, home health aides to provide personal care, counseling and respite support for caregivers, non-opioid pain management, memory fitness services, home and bathroom safety devices, transportation to and from the doctor, and some over-the-counter health items.
Because the rules were announced late in the year, only a small percentage of Medicare Advantage insurers began offering them in 2019. But you may find that a plan in your area is one of the few that does.
Bear in mind, however, that even if you switch to a plan that offers expanded features, you won’t necessarily be eligible for the new benefits. Check carefully to make sure you know the plan details and restrictions before making the switch, advises Lipschutz.
How to get more help
If you decide to switch plans for any reason, be aware that you may change plans only once during the special enrollment period. That’s different from the annual fall open enrollment period, when you can move back and forth between plans as much as you like up until the deadline.
Also, keep in mind that this is separate from the special circumstances that allow you to change plans at any time, including situations such as when your Medicare Advantage plan goes out of business or no longer covers your area.
For more information check Medicare.gov, where the agency’s Plan Finder tool can help you compare plans in your area, or call 800-633-4227.
For one-on-one help, you can contact your State Health Insurance Assistance Program (SHIP). To find yours, use this website or call 877-839-2675.