Don’t Like Your New Advantage Plan? Here’s What You Can Do.
When it comes to healthcare coverage, choosing the right plan can be a daunting task, especially if you are new to Medicare Advantage plans. Despite doing your research and selecting the plan that seemed best for you, you may find that the plan does not meet your expectations or needs. The good news is that you are not stuck with your Medicare Advantage plan for life. If you are not happy with your new Advantage plan, there are several options available to you. In this article, we will explore what you can do if you do not like your new Advantage plan and how to navigate the process of making changes to your healthcare coverage.
What is Medicare Advantage Plan?
Private insurance companies that contract with the federal government offer Medicare Advantage (MA) plans to provide Medicare benefits to beneficiaries, also known as Medicare Part C. The key difference between Medicare Advantage and Original Medicare is that Medicare Advantage plans are offered by private insurers, whereas Original Medicare is a federal health insurance program. Medicare Advantage plans often offer additional benefits that may not be covered by Original Medicare, such as prescription drug coverage, vision, dental, hearing, and wellness programs. However, Medicare Advantage plans have a limited network of healthcare providers, while Original Medicare allows beneficiaries to see any provider that accepts Medicare. Medicare Advantage plans may have lower out-of-pocket costs and different rules for accessing care, including the possibility of requiring referrals to see specialists or receive certain treatments.
Can I Change My Current Medicare Advantage Plan to Another?
Yes, you can change your current Medicare Advantage plan to another plan during certain times of the year. There are two main periods when you can make changes to your Medicare Advantage plan:
Annual Enrollment Period (AEP): The AEP occurs each year from October 15th to December 7th. During this time, you can switch from one Medicare Advantage plan to another, or you can switch from a Medicare Advantage plan back to Original Medicare.
Medicare Advantage Open Enrollment Period (OEP): The OEP occurs from January 1st to March 31st each year. During this time, you can make one change to your Medicare Advantage plan, such as switching to a different plan, dropping your plan and returning to Original Medicare, or adding or dropping prescription drug coverage (if your new plan has drug coverage).
It's important to note that there may be limitations on which Medicare Advantage plans you can switch to depending on where you live, and not all plans may be available in your area. It's also a good idea to review your current plan's coverage and costs before making any changes to ensure that the new plan meets your healthcare needs and budget.
What if I Switch from Medicare Advantage to Original Medicare?
If you switch from Medicare Advantage to Original Medicare, you will need to enroll in a separate prescription drug plan (Part D) if you want prescription drug coverage. You may also want to consider purchasing a supplemental insurance policy, also known as a Medigap policy, to help cover some of the out-of-pocket costs that Original Medicare doesn't cover, such as deductibles, coinsurance, and copayments.
When you leave a Medicare Advantage plan and return to Original Medicare, you will have a special enrollment period to enroll in a Part D plan and/or a Medigap policy. This enrollment period lasts for 63 days from the date your Medicare Advantage coverage ends. If you don't enroll in a Part D plan or Medigap policy during this period, you may have to pay a penalty or higher premiums if you decide to enroll later.
For example, if you switch Medicare Advantage Plans or go back to Original Medicare with a Medicare drug plan, your new coverage will start the first day of the month after your new plan gets your request for coverage. Changes to your enrollment will take effect on the first of the month following the month you enroll. For example, if you switch to a new Medicare Advantage plan on January 15, coverage will take effect on February 1.
Are Medicare Advantage Plans Bad?
While Medicare Advantage plans may offer some advantages, they may not be the best choice for everyone. Some reasons why some people may view them as "bad" or disadvantageous include:
Limited provider networks: Medicare Advantage plans often have limited provider networks, which means that you may not be able to see the doctors or specialists you want or need to see.
Prior authorization requirements: Some Medicare Advantage plans require prior authorization for certain services or procedures, which can be time-consuming and frustrating for both patients and providers.
Higher out-of-pocket costs for certain services: While some Medicare Advantage plans may have lower out-of-pocket costs for some services, they may have higher costs for other services, such as hospital stays or certain prescription drugs.
Potential for plan changes: Medicare Advantage plans can change their benefits and coverage from year to year, which can be confusing and may result in unexpected costs or coverage gaps.
However, it's worth noting that many people are satisfied with their Medicare Advantage plans and find them to be a good choice for their healthcare needs. As with any healthcare decision, it's important to carefully consider your options and choose the plan that best meets your needs and budget.
Medicare Advantage vs. Original Medicare Comparison
Medicare Advantage and Original Medicare are both health insurance programs available to eligible individuals in the United States. Here is a comparison of some key differences between the two programs:
Enrollment: Original Medicare is a government-run health insurance program that you are automatically enrolled in when you turn 65 or if you have certain disabilities. Medicare Advantage is a private health insurance option that you can enroll in instead of Original Medicare.
Coverage: Original Medicare consists of Part A (hospital insurance) and Part B (medical insurance), which cover a variety of healthcare services. Medicare Advantage plans, also known as Medicare Part C, offer all the benefits of Original Medicare, plus additional benefits such as prescription drug coverage, dental, vision, and hearing coverage.
Cost: Original Medicare typically has higher premiums and out-of-pocket costs for healthcare services than Medicare Advantage plans. However, Medicare Advantage plans may have additional costs such as copayments and deductibles.
Provider network: Original Medicare allows you to see any healthcare provider who accepts Medicare. Medicare Advantage plans have a network of healthcare providers you can choose from and may require you to get referrals to see specialists.
Additional benefits: Medicare Advantage plans may offer additional benefits not covered by Original Medicare, such as gym memberships, transportation, and home healthcare services.
Plan changes: Medicare Advantage plans can change their benefits and coverage from year to year, while Original Medicare benefits generally stay the same.
Choosing between Medicare Advantage and Original Medicare can be a complex decision, but here are some factors you may want to consider when making your choice:
Healthcare needs: Consider your current and anticipated healthcare needs, including any chronic conditions or prescription medications you take. Compare the benefits and costs of each plan to see which one will better meet your needs.
Budget: Consider your monthly budget and how much you can afford to pay for healthcare services. Compare the premiums, deductibles, copayments, and coinsurance of each plan to determine which one fits your budget.
Provider network: If you have a preferred healthcare provider or specialist, check to see if they are in the network of any Medicare Advantage plans you are considering. If you prefer the flexibility to see any provider who accepts Medicare, Original Medicare may be a better option for you.
Prescription drug coverage: If you take prescription medications, make sure to compare the costs and coverage of prescription drug plans offered by Medicare Advantage plans and Original Medicare.
Additional benefits: Medicare Advantage plans may offer additional benefits such as dental, vision, and hearing coverage, which may be important to you.
It's also a good idea to talk to your healthcare providers and a licensed insurance agent like here at Doctor’s Choice to help you make an informed decision. They can answer your questions and provide additional information to help you choose the plan that is right for you.