Making Medigap Plan Changes
For Medigap plans, enrollment periods are a little different. Its best to buy a Medigap policy during the 6-month period immediately after you first enroll in Medicare Part B.
You may be able to buy a Medigap plan after that, but there are no guarantees that an insurance company will sell you a policy.
Even if youre able to get a Medigap policy after the initial enrollment period, you may have to pay more.
If Youre Transitioning Into Or Out Of Inpatient Care
If youve been hospitalized as an inpatient and move out of state after discharge, your Medicare benefits wont be disrupted.
Hospitalization and inpatient care are covered under Medicare Part A, which is part of original Medicare and required to be a part of every Medicare Advantage plan.
While you may still need to switch your Medicare Advantage plan once you move, your Medicare Part A benefits will be covered either way.
What Drugs Are Covered Under Medicare Prescription Drug Coverage
Each plan provider will establish its own formulary, or list of prescription drugs, that it will cover. Although formularies must meet certain requirements set by Medicare, they still differ by plan.1
Generally speaking, Medicare prescription drug coverage covers drugs that meet the following criteria:
- They must be available only by prescription
- They must be approved by the Food and Drug Administration
- They must be used and sold in the United States
- They must be used for a medically necessary indication
Specifically, coverage will include:
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Are There Any Protections If I Enroll In A Plan And Do Not Like It
In order to enable beneficiaries to try a Medicare Advantage plan, but still have the option of returning to Original Medicare, a number of protections are in place. These protections will enable beneficiaries, in certain situations, to try a plan, but then return to Original Medicare and a Medicare Supplement policy if they want to do so.
Under these protections, beneficiaries will have guarantee issue of a Medicare Supplement policy as long as they meet one of the following criteria. For eligible beneficiaries, companies which sell supplement policies will not be able to deny coverage, charge more, or exclude benefits. However, to receive these protections, beneficiaries must apply for a supplement policy within 63 days of disenrolling from the health plan, or within 63 days of the termination of the health plan.
A beneficiary would be eligible for the Medicare Supplement protections if they meet one of the following criteria.
Case #1
You are enrolled in a Medicare Advantage plan and one of the following happens:
- The contract between Medicare and the plan ends.
- The plan service area no longer covers the county where you live.
- You move out of the plan service area.
- There are violations by the plan.
Protection: In this case, you would get a guaranteed issue of a Medicare Supplement Plan A, B, C, or F from any company .
Case #2
Case #3
Protection: You are guaranteed to get any Medicare Supplement plan with any company .
Case #4
Do I Need A Medicare Rx Plan
Medicare Part B covers a limited number of outpatient prescription drugs under limited conditions. Drugs covered under Part B are drugs youd have administered in a doctor’s office or hospital outpatient setting, such as a flu vaccine. You can view a list of these drugs at Medicare.gov.
For medications youd administer yourself, including maintenance medications and drugs prescribed by a doctor to take at home, youd want to consider a Medicare Rx plan or a Medicare Advantage plan that includes prescription drug coverage.
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Medicare Advantage Plans: Common Elements
- All plans have a contract with the Centers for Medicare and Medicaid Services .
- The plan must enroll anyone in the service area that has Part A and Part B, except for end-stage renal disease patients.
- Each plan must offer an annual enrollment period.
- You must pay your Medicare Part B premium.
- You pay any plan premium, deductibles, or copayments.
- All plans may provide additional benefits or services not covered by Medicare.
- There is usually less paperwork for you.
- The Centers for Medicare and Medicaid Services pays the plan a set amount for each month that a beneficiary is enrolled.
The Centers for Medicare and Medicaid Services monitors appeals and marketing plans. All plans, except for Private Fee-for-Service, must have a quality assurance program.
If you meet the following requirements, the Medicare Advantage plan must enroll you.
You may be under 65 and you cannot be denied coverage due to pre-existing conditions.
- You have Medicare Part A and Part B.
- You pay the Medicare Part B premium.
- You live in a county serviced by the plan.
- You pay the plan’s monthly premium.
- You are not receiving Medicare due to end-stage kidney disease.
Another type of Medicare Managed Health Maintenance Organization is a Cost Contract HMO. These plans have different requirements for enrollment.
Your Plan Is Discontinued
There are a variety of reasons why a Medicare plan might cease being offered, and all of them could mean that your private coverage is taken away.
- Low-performing Medicare Advantage or Medicare Part D plans may be discontinued by the Centers for Medicare and Medicaid Services .
- A private insurer may decide to restructure their plan offerings and drop a particular plan from their selection.
- An insurance company could go insolvent and shut their doors altogether.
Each of these scenarios would lead to the loss of your Medicare plan, but each would also grant you a Special Enrollment Period to sign up for a different plan.
If your Medicare Supplement Insurance plan is discontinued, you should be granted enrollment in a new plan under guaranteed issue rights, which means no medical underwriting would be used in your application process.
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How To Enroll In A New Medicare Plan
To make changes to your Medicare Advantage plan or Part D plan, youll need to find out what your plan options are in your new area. You can get information about available plans here. You can also learn about specific plans by calling the customer service number at the private company that offers it.
If you are dual-eligible and qualify for both Medicare and Medicaid, you will need to contact the state you will live in to find out your Medicaid benefit options. And, if you are interested in a dual eligible special needs plan, which is a plan that combines the benefits of Medicare and Medicaid, as well as often including additional benefits such as dental or vision care. Youll need to contact the private plan provider for information and availability of dual plans.
Cobra Coverage From An Employer Plan
Federal and state law allows people who leave their jobs to continue their employer-sponsored health coverage for a period of time. Be aware of the following:
- You have an eight-month period after your employment ends to enroll in Medicare. If you dont enroll during that eight-month window, you might have to pay a penalty when you enroll.
- If youre in your Medicare initial enrollment period, you must enroll in Medicare during that time to avoid a possible penalty.
- If you dont buy a Medicare supplement policy during your open enrollment period, youll be able to buy some Medicare supplement plans within 63 days of losing your COBRA coverage.
Talk to your employer about COBRA and Medicare eligibility.
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Moving Into Or Out Of A Skilled Nursing Facility Or Long
Moving into or out of a skilled nursing or long-term care facility opens several options for switching or dropping a Medicare Advantage or Part D plan. You can:
- Join a Medicare Advantage or Medicare Part D plan
- Switch from your current plan to another Medicare Advantage or Part D plan
- Drop your Medicare Advantage plan and return to Original Medicare
- Drop your Medicare Part D plan
You can join, switch or drop coverage for as long as you live in the facility and for two full months after the month you leave the facility.
Open Enrollment For Texans With Disabilities
People under age 65 who get Medicare because of disabilities have a six-month open enrollment period beginning the day they enroll in Medicare Part B. This open enrollment right only applies to Medicare supplement Plan A.
Note: People who have Medicare because of disabilities have another open enrollment period during the first six months after turning 65.
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Learn About Medicare Plan Options Where Youre Moving
As you prepare for your move, you may want to call and speak with a licensed insurance agent to learn more about the Medicare Advantage plans that may be available where youve moving. A licensed agent can help you compare plan coverage, benefits, costs and more.
You can also compare plans online for free, with no obligation to enroll.
Compare Medicare Advantage plans in your area and where you’re moving
What Happens If You Need To Change Plans During A Period You Cannot Change Plans
The only way to change Medicare Advantage Plans outside of the standard annual enrollment periods is by qualifying for a Special Enrollment Period. include, but are not limited to:
- Moving outside of your current plans service area.
- Moving to a new address within your current plans service area but which has new plan options.
- Moving into or out of a skilled nursing facility or long-term hospital care.
- You are eligible for both Medicare and Medicaid.
- Becoming ineligible for Medicaid.
- If Medicare takes an official action because of a problem with your current plan that affects you.
- If Medicare terminates or does not renew your current plans contract.
- You joined a plan or chose not to join a plan due to an error by a federal employee.
You generally have 2 months to make a change to your Medicare Advantage Plan during a SEP.
For a complete list of special circumstances that qualify you for a SEP, click here: Special circumstances .
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Can I Keep My Part D Prescription Drug Plan When I Move
You may not be able to keep your Part D prescription plan depending on where you move. Not all plans are available throughout the country, so you should check with your provider ahead of time. You can shop for new plans in the month before you move so that you have one less thing to worry about as you prepare your new home. If you dont switch your coverage in a timely fashion, you may have to wait until the Annual Enrollment Period to pick up a new drug plan. When youre doing your shopping, you may even find that theres a plan that costs you less than your original plan.
The Type Of Medicare You Have Dictates What You Need To Do
As a general rule, plans that require you to use a specific network of service providers and plans that differ from area to area will need to be changed if youre moving out of the plans service area. Plans that dont require you to use in-network providers might not need to be changed. However, the rules about whether or not youre allowed to change plans, and if so, the timeframe in which youre allowed to change the plan, are complicated.
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Moving Out Of State With Original Medicare
If you have Original Medicare , you can go ahead and move without worrying about whether your coverage is portable. Original Medicare doesnt have networks, so you can use any doctor or hospital anywhere in the country that takes Medicare.
Theres a Physician Compare service at Medicare.gov that may be helpful as you search for providers in your new home state. To keep your healthcare costs low, filter your search by doctors that accept Medicare assignment. This means that they dont charge more than the Medicare-approved fees for specific healthcare services. You will be responsible for applicable deductibles and copayments, but your out-of-pocket costs may be lower than if you choose a doctor that does not accept assignment.
Are Any Medicare Managed Care Plans Available Where I Live
Currently, you can choose from three types of Medicare Managed Care:
- Cost Contract HMO
- Medicare Advantage PPO
- Medicare Advantage PFFS
These plans are available in selected counties of Indiana and it is important to know the differences between them.
Cost Contract HMO
Medicare will reimburse the plan for covered services you receive. You choose a primary care provider within the HMO network. When you stay within the network, you pay nothing except the plan premium and any small copayment amounts preset by the HMO.
You may also choose to use services outside of the network. When you choose to use a service or provider outside the Cost Contract HMO network, Medicare would still pay their usual share of the approved amount. You would be responsible for the Medicare deductibles and copayments. The Cost Contract HMO would not pay these. Cost Contract HMOs may enroll you if you don’t have Medicare Part A but have and pay for Medicare Part B. Cost Contract HMOs do not have to enroll you if you have end-stage kidney disease or are already enrolled in the Medicare hospice program.
Medicare Advantage PPO
This type of managed care plan maintains a list of preferred providers but lets you see doctors and hospitals outside the plan for an additional cost. If you choose to use a provider outside of the network, the plan will pay the same reimbursements as Original Medicare will unless you need emergency or urgent care.
Medicare Advantage PFFS
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How To Transfer Original Medicare To Another State
Those with Original Medicare planning a move to a new state go through a simple process to update residency. There is no need to update your plans or enroll in new coverage. Medicare is a federal program with no provider networks. So, coverage is the same in all 50 states.
The only step that you will need to take is updating your address through Social Security. If applicable, you may also contact the Railroad Retirement Board to update your address.
Keep in mind, it is important to find a new primary care doctor in your area who will be taking over your care. You will want to do this as soon as possible to avoid a delay in care when necessary. It is important to ensure your new primary care doctor accepts Medicare so you will be able to use your benefits when receiving care. To ensure your physician accepts Medicare, you can call the office and speak with them yourself or use the Medicare physician finder online tool.
What Happens To Part C
Medicare Part C, also known as Medicare Advantage Plans, will most likely need to change if you move, because your health networks are based off local physicians and health providers. You can choose to enroll in Original Medicare, or find a new HMO or PPO you want to join in your new local area.
Plans vary from state to state, so depending on where you move you may be paying less or more than you initially were. If you are unable to afford the new Medicare costs after you move, you can contact an agent to find a possibly cheaper option in your new state.
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You Fail To Pay Your Plan Premiums
Not paying your premium is perhaps the easiest way to lose Medicare coverage.
If you fall behind on your premium payments for Original Medicare, you will receive a Second Notice . If you do not pay by the deadline indicated on the Second Notice, you will receive a Delinquent Notice. If you do not pay your premium by the 25th day of that month, your Medicare coverage may be terminated.
For other types of Medicare plans such as Medicare Advantage, Medicare Part D or Medicare Supplement Insurance, the protocol for termination may vary by carrier. But its important to remember that enrollment in these types of Medicare coverage is contingent on your enrollment in Medicare Parts A and Part B.
This means that if you lose Medicare Part A or Part B because of failing to pay plan premiums, you may also lose your private Medicare plan coverage. Be sure to contact your plan carrier for more information.
How Does Medicare Work When You Move To A Different State
Medicare is a federal healthcare program for people age 65 and over, as well as those who have certain health conditions or disabilities.
Because its a federal program, Medicare provides services in every part of the country. It doesnt matter which state you live in your basic Medicare coverage will stay the same.
Although your Medicare coverage wont end or change when you move, youll often need to find new healthcare professionals who participate in Medicare. Doctors must accept Medicares payment terms and meet certain requirements to participate in the program.
Regardless of where you live, participating doctors and healthcare professionals will submit a bill to Medicare for the services they provide to you.
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How To Transfer Medicare To Another State
If you are a Medicare beneficiary, moving to another state can lead to a lapse in coverage unless you make plans before you move. Apart from Original Medicare and Medigap plans, which can be transferred to a different state, you may need to switch to a new Medicare Advantage and Prescription Drug plan that is available in your area.
The following steps can help you avoid a lapse in coverage when switching Medicare to another state.
