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Health Insurance Basics

3 Steps for Switching Medicare Advantage Plans

February 19, 2019

Today, Medicare participants have an annual open enrollment period every October 15–December 7 when they can change Medicare Advantage plans. It’s important to review your Medicare options annually, because plan benefits and costs can change from year to year, and you may find a different plan that simplifies your healthcare experience.

Step One – Review Your Current Plan … Before the Enrollment Period Starts

Deciding whether to switch Medicare Advantage plans begins by understanding your current costs, usage and benefits. Start this first step before open enrollment begins by answering a few questions:

  • How much are you paying for coverage? Add up your monthly premium costs for your current coverage, whether that’s Medicare Part B with a supplemental Medigap policy, Part D drug coverage costs, or your monthly Medicare Advantage plan premium.
  • What added costs have you paid in the last year? You might have paid deductibles, copays or coinsurance; or you might have needed medical services not covered under your current plan.
  • What coverage might you need over the next year? If your health has changed or you think a major procedure like a knee replacement might be in your future, how much might you pay for out-of-pocket costs?
Step Two – Understand Your Options

Medicare isn’t a one-size-fits-all program. You have choices each open enrollment period. Here are options to consider:

  • Original Medicare, which includes Part A (for inpatient hospital stays, skilled nursing facility stays, hospice care and some home health care) and Part B (for certain doctors’ services, outpatient care, medical supplies and preventive services). Part A is free for most people, and Part B has a premium ($134 for most in 2018) that can be deducted from your Social Security payment if you are receiving one.
  • Medigap supplemental coverage, also known as Medicare Supplement insurance, is designed for those with original Medicare. This private insurance covers some of the out- of-pocket costs not covered under original Medicare Parts A and B, including some coinsurance and copayment obligations, and may include additional benefits such as membership to a fitness program. There are 11 standard Medigap plans to choose from.
  • Part D prescription drug coverage is a Medicare benefit offered through private insurers. Each insurer’s plan has its own list, called a formulary, of the drugs it covers. Formularies can change from year to year, so check to make sure any prescriptions you are currently taking will still be covered if you renew with the same plan.
  • Medicare Advantage plans, also called Part C plans, are offered by private insurers and combine coverage for hospital stays and doctor visits — and most plans also cover prescriptions. In addition, some plans also include vision, hearing and dental services, fitness program membership, and other extra benefits. You must sign up for Medicare Parts A and B to get a Medicare Advantage plan. You pay your standard Part B premium, plus a possible additional premium the insurer may charge.
Step Three – Get Help if You Need It

There’s no doubt that changing Medicare Advantage plans can be confusing. However, there are online and in- person resources available to help you understand your options. These include:

  • State Health Insurance Assistance Programs (SHIPs) are sponsored by Medicare in every state. They provide free assistance to Medicare beneficiaries and their families and caregivers.
  • The National Council on Aging’s Medicare Matters website offers comparison tools to help you find the best plans for you.
  • Your insurer, especially if you’re already enrolled in a Medicare Advantage plan or Medicare Supplement coverage, may offer phone assistance or online resources to help you choose between varying health and drug plans. They may also be able to inform you about any new, innovative benefits being introduced.

Following these three steps can help you better understand your options and help ensure the plan you choose is the best available for your health needs and budget. But perhaps the most important step is simply remembering the open enrollment timeline. There’s a tool for this step, as well — you can sign up for an emailed reminder when it’s time to begin your comparisons, and when the December 7 deadline approaches.

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This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium.
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