Reasons People Leave Or Change Medicare Advantage Plans
There are several reasons why someone may want to leave or change their Medicare Advantage plan. The common thread is that the plan may not be right for them because their plans costs and coverage has changed.
Why People Switch or Drop Medicare Advantage Plans
- One of your doctors is not part of the plans network
- A drug you need is no longer part of the plans formulary
- Limited doctor or hospital network
- Coinsurance or copayments are too high
- Additional benefits are not worth it
Fact #: Medicare Supplement Insurance Plans Can Help Cover Additional Or Unanticipated Costs
Briefly, Medicare is divided into two primary parts , each covering different health care needs.
Medicare Part A helps pay most fees for hospital stays, except Part A deductibles, coinsurance amounts and doctor services. Depending upon you or your spouses work history, you may either qualify for premium-free Part A or pay a premium determined by how long you worked and contributed to Medicare taxes.
Medicare Part B helps cover services from doctors, outpatient and home health care providers as well as durable medical equipment, and many protective services such as shots, vaccines and wellness checkups but NOT long-term care, vision or dental care, hearing aids, eyeglasses or private nursing. It typically pays up to 80 percent of your medical expenses after the annual deductible.1
Note: Medigap plans sold to people new to Medicare can no longer cover the Part B deductible.
Obviously, its critical to take action during the annual, end-of-year enrollment period. Its also worthwhile to collaborate with a professional who can help you navigate the finer points of your coverage.
What Plan Changes Can I Make During The Medicare Open Enrollment Period
During the Medicare open enrollment period, you can:
- Switch from Original Medicare to Medicare Advantage .
- Switch from Medicare Advantage to Original Medicare .
- Switch from one Medicare Advantage plan to another.
- Switch from one Medicare Part D prescription drug plan to another.
- Enroll in a Medicare Part D plan if you didnt enroll when you were first eligible for Medicare. If you havent maintained other , a late-enrollment penalty may apply.
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Medicare Annual Enrollment Period
If you choose not to sign up for a Medicare Advantage plan or stand-alone Medicare prescription drug coverage during your Initial Enrollment Period, you can also enroll in a Medicare Advantage plan during the annual Fall Medicare Annual Enrollment Period .
AEP is also called the Medicare Annual Election Period and the Open Enrollment Period for Medicare Advantage and Medicare prescription drug coverage.
This period runs from October 15 to December 7 every year.
During the Fall Medicare Open Enrollment Period for Medicare Advantage and Medicare prescription drug coverage, you can:
- Enroll in, make changes to or disenroll from a Medicare Advantage plan
- Enroll in, make changes to or disenroll from a Medicare Prescription Drug plan
Plan changes you make during the 2022 Medicare Fall Annual Enrollment Period go into effect January 2023.
Initial Enrollment Period For New Medicare Beneficiaries
Your Initial Enrollment Period for Medicare is a seven-month Medicare enrollment period that allows you to enroll in Medicare Part A and Medicare Part B. You will receive this enrollment period upon your 65th birthday or receiving your 24th Social Security disability check, whichever comes first.
During your Initial Enrollment Period, you can enroll in both parts of Original Medicare or opt to delay Medicare Part B. For most, enrolling in Medicare Part A is a no brainer due to its $0 monthly premium. However, if you have creditable coverage in place, it is not uncommon to delay Medicare Part B benefits.
The Initial Enrollment Period begins three months before your Medicare enrollment qualifying event, the month of, and ends three months after your qualifying event. For most, this enrollment period happens around their 65th birthday.For example, if you turn 65 on June 1, your enrollment period begins on March 1 and ends on September 30.
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If you enroll in Medicare during the three months before your 65th birthday, your Original Medicare benefits will go into effect on the first day of your birth month. If you enroll during your birth month or in the three months following, coverage will begin on the first day of the following month.
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Enrollments And Changes You Can Make During The Annual Open Enrollment Period
Open enrollment is an annual opportunity for Medicare beneficiaries to reevaluate their current plan benefits rather than enrolling for the first time.
You should weigh changes in coverage and out-of-pocket costs including Medicare deductibles, coinsurance, copayments and premiums.
Enroll or Switch During the Annual Medicare Open Enrollment Period
Reviewing Your Medicare Options
If you would like to enroll in a different Medicare Advantage plan during the next Annual Election Period, it is a good idea to review all available plan options in your area to find one that best suits your needs. As you can see, when you enroll in a Medicare Advantage plan, the timing is important. To start comparing Medicare Advantage plans now, click the Compare Plans buttons on this page.
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Can I Change My Medicare Coverage Outside Of The Medicare Open Enrollment Period
You can, but generally only under special circumstances that qualify you for a Special Enrollment Period . These circumstances include moving to a new location that is outside of your current plans service area or where additional plan options are available, moving back into the U.S. after living abroad, moving into or out of a facility, or if Medicare terminates your current Medicare Advantage plan.
Some beneficiaries can change coverage on a quarterly basis. This includes enrollees who receive assistance from Medicaid and enrollees who receive Extra Help paying their Medicare drug plan premiums and cost sharing, who can switch Part D plans or Medicare Advantage plans once per calendar quarter in the first three quarters of the year, and during the Medicare Open Enrollment period that runs from October 15 through December 7 each year. Some beneficiaries can change coverage from month to month. This includes beneficiaries in certain institutions, such as nursing homes, who can switch Medicare Advantage or Part D plans once a month for as long as they are living there.
Are There Enrollment Periods For Medicare Advantage Plans
Once you have enrolled in Original Medicare, you can begin enrolling in additional coverage plans. One of these plans include Medicare Advantage plans.
Medicare Advantage plans are offered through private insurance companies and offer additional benefits to Original Medicare coverage. Often, these plans provide dental, hearing, vision, and drug coverage as well as gym memberships to enrollees. On the other hand, these plans tend to have high out-of-pocket costs and are more restrictive than Original Medicare.
To enroll in a Medicare Advantage plan, you will want to utilize your Initial Coverage Election Period. This enrollment period is the same seven-month period as your Initial Enrollment Period.
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If you wish to enroll in a Medicare Advantage plan it must be done during your Initial Coverage Election Period. If you miss your Initial Coverage Election Period, you may have to wait until the Annual Enrollment Period to enroll in a Medicare Advantage plan for the following year.
Additionally, if you enroll in Original Medicare during the General Enrollment Period, you will have a Special Enrollment Period to enroll in a Medicare Advantage plan.
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Medicare Supplement Insurance Enrollment
If you have Original Medicare and would like to enroll in a Medicare Supplement Insurance plan , the best time to sign up is during your six-month Medigap Open Enrollment Period.
- Your Medigap Open Enrollment Period starts as soon as you are age 65 or older and are enrolled in Medicare Part B.
- Insurance companies cannot deny you Medigap coverage or charge you a higher fee for pre-existing health conditions if you apply for Medicare Supplement Insurance during your Medigap Open Enrollment Period.
If you dont sign up for a Medigap plan during your Medigap Open Enrollment Period, you may still be able to buy one at any time.
Insurance companies can take your health into consideration when setting your premiums or deciding whether or not to offer you coverage, however.
You must be enrolled in Medicare Part A and Part B in order to buy a Medigap plan.
Medigap and Medicare Advantage plans are very different, and you cannot be enrolled in a Medigap plan and a Medicare Advantage plan at the same time.
Learn more about the differences between Medicare Advantage vs. Medicare Supplement Insurance.
Request a free, no-obligation Medicare Supplement Insurance quote today by visiting MedicareSupplement.com.
When Is The Annual Open Enrollment Period
The Annual Enrollment Period, or AEP, is from of each year. During this window, every Medicare beneficiary has the right to:
- Start Medicare Advantage coverage
- Enroll in a Part D drug plan
- Change Part D drug plans
- Drop Medicare Advantage coverage and return to Original Medicare
If you drop Medicare Advantage coverage during AEP, you can enroll in a standalone Part D drug plan. You can also apply for a Medicare Supplement insurance plan. Depending on your circumstances, you might have to go through underwriting, where your coverage could possibly be denied.
There are a few other changes you can make during AEP, like enrolling in a Medicare Cost plan. These options may not be available in all areas.
During AEP, you can make an unlimited number of changes regarding your chosen plan. Any changes you make will become effective on January 1 of the following year.
RELATED: Speak with a licensed Medicare insurance agent by calling: .
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The Best Time To Sign Up For Medicare
The Initial Enrollment Period is the best time to sign up for Medicare. Once you have Medicare Part A and Medicare Part B , you may join an Advantage plan.
Your IEP occurs during the 7 months surrounding your Medicare eligibility date. If you age into the Medicare program , your Initial Enrollment Period begins 3 months before the month of your birthday and ends 3 months after your birth month. If you qualify for Medicare due to a disability, your IEP begins 3 months before your 25th month of collecting Railroad Retirement Board or Social Security benefits.
So, if your birthday or 25th month of collecting disability benefits occurs in June, your IEP begins March 1 and ends September 30. The only difference is if your birthday is on the first of the month. In that case, your IEP begins and ends one month earlier .
You are only automatically enrolled in Medicare if you began collecting Social Security benefits at least 4 months before your 65th birthday. Everyone else has to apply for Medicare through Social Security.
What Is The Medicare Enrollment Period
Medicare enrollment periods can be confusing because different enrollment periods have different dates for various purposes. There are many enrollment periods for people signing up for Medicare benefits for the first time. When you are new to Medicare, you may not need to apply for benefits. You could be automatically enrolled in Medicare coverage if you meet a few requirements.
If you do not qualify for automatic enrollment, you will need to utilize the Initial Enrollment Period.
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Hap Is Here Helping You Understand Your Medicare Coverage Options
Each year, you can join, switch or drop a Medicare Advantage Plan during the Annual Enrollment Period which happens from Oct. 15 to Dec. 7. When you choose a plan during this period, your plan will become effective on Jan. 1 of the following year.
If you are not satisfied with your Medicare Advantage plan in the new year, you can switch. You can now make one change during the Medicare Advantage Open Enrollment Period which happens between Jan. 1 and Mar. 31 each year.
When Else Can You Enroll In Medicare Advantage Plans
This open enrollment period may give you another chance to make Medicare coverage changes, in addition to the times listed below. You canât change Medicare Advantage plans anytime you want, in most cases.
Usually you can only add, drop or change Medicare Advantage plans or Medicare prescription drug plans during:
- Your Medicare Initial Enrollment Period or Medicare Advantage Initial Coverage Election Period
- A Special Enrollment Period, if you qualify for one
- A 5-star Special Enrollment Period for a Medicare health or prescription drug plan
Read more about Medicare Advantage enrollment periods
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Switching From Medicare Advantage To Original Medicare
Instead of switching Medicare Advantage plans during the open enrollment, you may choose to leave your plan altogether in favor of Original Medicare. Some of the reasons for changing from Medicare Part C to Original Medicare include:
- Changes to your plan coverage that youre unhappy with
- An increase in plan premiums, deductibles, copays or coinsurance
- Shifting coverage needs
- Your doctor is no longer considered part of your plans network
Moving from Medicare Advantage to Original Medicare could save you money if youre no longer responsible for copayments. But its still important to consider your overall costs. Heres what the typical person might pay for Medicare Parts A and B in 2022:
- Part A Premium: Most people dont have a premium for Part A but for those who do, the standard premium up to $499 per month
- Part A Deductible: $1,556 for each benefit period
- Part A Coinsurance: $0 coinsurance for days 1-60 $389 for days 61-90 $778 for days 91 and beyond
- Part B Premium: Standard premium is $170.10, though it may be higher based on income and filing status
- Part B Deductible: $233
- Part B Coinsurance: Typically 20% of the Medicare-approved amount after your deductible is met
Doing the math based on your anticipated healthcare costs and income can help you determine if it makes sense financially to switch back to original Medicare or stick with your Medicare Advantage plan.
Medicare Supplement Open Enrollment Period
If youre looking to supplement your Original Medicare coverage to help with additional costs, the best time to buy a Medicare Supplement plan is during the six-month enrollment period that starts the first day of the month you turn 65 as long as you have signed up for Medicare Part B.
If you dont sign up for a Medicare Supplement plan during this Open Enrollment Period, you may not be able to buy a Medicare Supplement plan. Unless you have a guaranteed issue right, you may be required to answer medical questions.
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How To Sign Up For And Change Medicare Plans
Once youre enrolled in Medicare, youll have various opportunities to change certain aspects of your coverage. Heres an overview:
- During the annual open enrollment period , you can make a variety of changes, none of which involve medical underwriting:
- Switch from Medicare Advantage to Original Medicare or vice versa.
- Switch from one Medicare Advantage plan to another.
- Switch from one Part D prescription plan to another. Its highly recommended that all beneficiaries use Medicares plan finder tool each year to compare the available Part D plans, as opposed to simply letting an existing drug plan auto-renew.
- Join a Medicare Part D plan.
- Drop your Part D coverage altogether.
You Can Make These Changes During The Medicare Advantage Open Enrollment Period:
- If you have a Medicare Advantage plan , you can switch to another Medicare Advantage Plan . You can choose a different plan with your current health insurer or a new plan with a new health insurer.
- You can drop your Medicare Advantage Plan and return to Original Medicare. You’ll also be able to join a Medicare Prescription Drug Plan.
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What Changes Are Off Limits With The New Medicare Advantage Open Enrollment Period
Not all 2022 Medicare Advantage plans will have the new benefits, and there may be benefit caps and other rules that apply for those that do. For example, plans may limit the non-medical transportation to 20 trips a year and require you to use certain providers before benefits apply.
During the new Open Enrollment Period for Medicare Advantage, you generally cannot:
- Sign up for a Medicare Advantage plan when youâre not already enrolled in one. In other words, you can switch plans, but not get one for the first time.
- Sign up for a stand-alone Medicare Part D prescription drug plan . But suppose youâre losing this type of coverage by dropping a Medicare Advantage prescription drug plan . You might be able to sign up for a PDP in these cases.
- Switch from one stand-alone Medicare Part D prescription drug plan to another.
The Medicare Advantage Open Enrollment Period doesnât apply to other types of Medicare health plans, such as Medicare Savings Accounts, Medicare Cost plans, or the PACE program .
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