Medicare Your Coverage Options

Medicare Open Enrollment: Consider changing health plans

Written by Diane Archer

Medicare Open Enrollment begins on October 15 and runs through December 7. During this time, older adults and people with disabilities can switch Medicare health plans. They can also switch from one Part D prescription drug plan to another. You should consider changing health plans during Medicare Open Enrollment. And, after this open enrollment period ends, if you are enrolled in a Medicare Advantage Plan and would like to disenroll and switch to traditional Medicare, you can do so between January 1 and February 14. To learn more and get free advice, call your State Health Insurance Assistance Program at 800-677-1116.

If you’re enrolled in a Medicare Advantage plan or a Part D drug program, look at how your current plan is changing and your options. You may want to switch plans. Health plan costs and benefits often change significantly from one year to the next. Although it’s hard to know whether a health plan will meet your future health care needs, you may be able to save money by switching. Before you make your choice, keep these facts in mind.

  • Traditional Medicare:
    • Traditional Medicare, the government health insurance option, is the Medicare health plan choice for seven out of ten people with Medicare.
    • Traditional Medicare offers coverage from almost all doctors and hospitals anywhere in the country.
    • Traditional Medicare charges a deductible—the amount you pay before coverage begins–and coinsurance for most of your care.
    • Supplemental insurance—Medicaid, retiree coverage from a job or a Medicare supplemental insurance plan you can buy–generally fills most or all coverage gaps. If you’re in traditional Medicare, be sure you have supplemental insurance, which protects you from catastrophic costs and allows you to budget for your health care.
  • Medicare Advantage plans:
    • Commercial health plans that contract with Medicare
    • Medicare Advantage plans generally limit coverage to a small group of doctors and hospitals in your community—the provider network–except in emergencies or urgent care situations. The provider network can change at any time with doctors and hospitals leaving and entering the network.
    • Medicare Advantage plans often charge an additional premium, a deductible (the amount you pay before coverage begins) and a copay or coinsurance, with each health care visit. These costs can change from one year to the next. You cannot buy insurance to fill these coverage gaps.
    • Medicare Advantage plans can be less costly than traditional Medicare if you see doctors in the network and do not have a complex condition requiring substantial health care services.
    • When people need costly services, they often struggle in their Medicare Advantage plans. Their out-of-pocket costs can easily reach the $6,850 limit for in-network care and far more if they want to use specialists out of network.

If you’re in a Medicare Advantage plan now:

  • Check your health plan’s Annual Notice of Change (ANOC) or Evidence of Coverage (EOC). Look at the plan’s new premiums, deductibles and copays. If those are good with you, also check to make sure your doctors and hospital are still in the network.
  • It’s also wise to look at your other health plan options, including traditional Medicare. One of those options may better meet your needs. You can call your State Health Insurance Program or SHIP for help sorting through your options. You can also call 1-800-633-4227 (1-800-Medicare) or use this Medicare tool to understand your options.
  • Before making a switch to another Medicare Advantage plan, call the plan to confirm your understanding of costs and network doctors and hospitals.
  • If you do want to switch to another Medicare Advantage plan, call 1-800-633-4227 (1-800-Medicare) to let Medicare know about your decision.
  • If you are unhappy with your Medicare Advantage plan choice, you have the right to disenroll any time between January 1 and February 14 and switch into traditional Medicare.

If you have a Medicare Part D prescription drug plan:

  • Check your Part D drug plan’s Annual Notice of Change (ANOC) or Evidence of Coverage (EOC). Look at the plan’s new premiums, deductibles and copays or coinsurance. If those seem good to you, check the costs for the drugs you’re taking.
  • It’s wise to look at other drug plan options. You might find a plan that covers your drugs at lower cost. Medicare offers a tool for comparing drug plans based on your drug needs.

If you decide to switch plans, your new coverage will begin on January 1.

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