How Do I Change Medicare Plans During Open Enrollment?
Key takeaways:
The costs you pay and the coverage you get from your Medicare setup may no longer suit you. If so, switching may save you money.
Changing your Medicare plan can be challenging, so it’s wise to seek out help.
You’ll need to schedule your switch to take place during the appropriate enrollment period.
Switching Medicare plans during the open enrollment period (October 15 through December 7) can be a smart move if your needs or costs have changed. For example, changes in your income or financial situation could have affected your monthly premium. Your Part D prescription drug plan or Medicare Advantage plan might have raised premiums, deductibles, or changed its cost-sharing percentages.
Whether you’re unsatisfied with your current Medicare plan, your needs have shifted, or you just want to find out if there’s a plan that’s better suited or more affordable for you, it’s always wise to re-evaluate your coverage during open enrollment. If you don’t know where to start, the counselors at your local State Health Insurance Assistance Program (SHIP) can help you sort through your choices for free.
Should I change Medicare plans?
Here are nine of the most common reasons to consider changing your Medicare plan during the annual open enrollment period:
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1) Your prescription medications have changed in some way. For example, you may have started a new medication, switched from a brand-name drug to its generic version, or substituted one drug for another.
If your prescription drugs aren’t in your plan’s formulary, you’ll want to find a different plan that covers all or most of your current prescriptions. Also, drug costs often change from year to year, so it’s wise to check that your medications will still be affordable on your plan. Refer to the Annual Notice of Change letter that Part D plans and Medicare Advantage plans are required to send by October for how your plan’s costs and coverage may shift in the coming year.
2) You expect to have surgery in the coming year and want a Medicare supplement (Medigap) plan to help with out-of-pocket costs. Deductibles, copayments, and coinsurance can add up for original Medicare enrollees.
3) You need routine dental, hearing, or vision care coverage, and your current coverage doesn’t include it. Original Medicare (Parts A and B) doesn’t cover these three benefits. If you’re looking for dental, hearing, and vision benefits specifically, you’ll want to focus on Medicare Advantage plans, which often provide them.
4) You no longer need one or more of your current benefits. You may be able to save money by moving to a cheaper plan without them.
5) Your premium has gone up, and there’s another plan that offers similar coverage for a lower premium.
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6) You can’t afford or don’t want to pay a high deductible. You’d prefer a plan that offers a low or $0 deductible in exchange for a higher monthly premium.
7) Your current plan has changed or discontinued some of its benefits.
8) You plan to move, travel, or live somewhere else for part of the year. Many Medicare Advantage plans don’t cover out-of-network care, and if they do, they may charge more for that flexibility. Many limit routine care to specific geographic areas.
9) You have changed doctors, and the new one isn’t in your current plan’s network.
How do I make the switch?
The actions you need to take, and when to take them, depend on what kind of plan you have now and what kind of plan you want to move to.
Here’s what to do if you’re:
Switching from original Medicare to join a Medicare Advantage (MA) plan: During the annual open enrollment period (October 15 to December 7), join the Medicare Advantage plan. As soon as that plan’s coverage goes into effect, you will be automatically disenrolled from original Medicare. Make sure you have drug coverage either through your new MA plan or a standalone Part D plan.
Switching from one Medicare Advantage plan to another: You can do this either during the standard open enrollment period or during the MA open enrollment period (January 1 to March 31). For this change, too, you can simply enroll in your preferred MA plan. Once the new coverage kicks in, you’ll be disenrolled from the old plan.
Switching from a Medicare Advantage plan to original Medicare: You can make this switch during either the open enrollment period or the Medicare Advantage open enrollment period. You can do this by contacting the provider of your MA plan or by calling Medicare at 1-800-MEDICARE (1-800-633-4227 / TTY 1-877-486-2048).
Switch from one Medicare Part D plan to another: If you have original Medicare and are enrolled in a stand-alone Part D plan that you want to replace, you can do that during the fall open enrollment period. Call 1-800-MEDICARE to enroll in your new plan before you exit your old one.
Switching from one type of Medicare supplement insurance (Medigap) policy to another: Medigap insurance has no annual open enrollment periods. Most experts suggest that, during the first 6 months after you enroll in Medicare Part B (a window sometimes called the “Medigap open enrollment” period), you sign up for the most comprehensive Medigap policy you can afford.
That’s prudent, because during this time you have guaranteed issue rights. That means the company behind your chosen Medigap policy must accept you without requiring medical underwriting — health tests that could bump up your premium or disqualify you altogether. If you decide to change from one Medigap policy to another later on, you’ll probably have to undergo a physical exam and could get charged more or even rejected because of pre-existing conditions.
If you do want to make a change, don’t cancel your current policy right away. You’re entitled to have a 30-day “free look” period once the new policy takes effect (though you’ll have to pay the premium for both policies during that month). If the new one doesn’t suit you, you can return to the old one.
Switching from a Medicare Advantage plan to original Medicare so that you can get a Medigap policy: This is tricky. You can switch to original Medicare during either the October-December open enrollment period or the January-March MA enrollment period, and you can apply for Medigap at any time.
But if your Medigap open enrollment window has ended, or a trial right doesn’t apply to you, your application may require medical underwriting. This means you could get rejected due to pre-existing conditions. It also depends where you live. A few states have added protections that allow you to skip underwriting and make for easier Medigap switching. Ask your SHIP for details.
You might want to hedge your bets by submitting your Medigap application for an issuance decision before actually disenrolling from your current Medicare Advantage plan. Consult your local SHIP advisor about this.
The bottom line
The timing and process of switching from one type of Medicare coverage to another mostly depends on the type of plan you have now and the type of plan you want instead. For most changes, you can take the necessary steps during the annual open enrollment period that begins on October 15. It’s also OK to switch between Medicare Advantage plans during the first 3 months of the calendar year. Your local SHIP office can help you with decision-making and filling out applications.
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References
Medicare.gov. (n.d.). Guaranteed issue rights.
Medicare.gov. (n.d.). How to join a Medicare Advantage plan.
Medicare.gov. (n.d.). Medigap & Medicare Advantage plans.
Medicare.gov. (n.d.). Plan annual notice of change (ANOC).
Medicare.gov. (n.d.). Switching Medigap policies.
State Health Insurance Assistance Program. (n.d.). SHIP.
