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Medicare allows you to switch Medicare plans. But there are rules and dates that apply. Some of them are commonly known but others are lesser-known opportunities to change from one Medicare plan to another. The following are ways to change Medicare plans.
There are nearly 63 million Americans with Medicare (2022). Here’s the breakdown of plan choices;
Original Medicare Only (Parts A & B): 21.4 million
Medicare Advantage (Part C): 26 million
Medigap (Medicare Supplement): 14.6 million
Important Notice for Consumers: Make sure to enroll in a permitted and timely manner to avoid gaps in coverage. Your new coverage should be confirmed before you drop any existing coverage. When switching plans, you can benefit by speaking to a local Medicare agent who will assist you through the process. Click the link to access the Association’s online directory listing local Medicare agents near me.
Here are ways, rules and opportunities to switch between Medicare plans.
Switching Medicare plans is doable. But, doing it wrong can mean you’ll pay more money. Or worse, not be covered. Here are questions to ask to help make sure you are doing things correctly.
WHY WOULD PEOPLE SWITCH MEDICARE ADVANTAGE PLANS?
FOUR KEY REASONS: Your preferred healthcare providers are no longer in-network. Your medications got more expensive. There are cheaper plans with equal or better coverage. You want a plan with extra (free) benefits. In 2020, 74 percent of MA plans offered a fitness benefit, 74 percent offered a dental benefit and 79 percent paid for eye exams and glasses. If your plan doesn’t offer these features, finding one that does could save you money.
When can you change?
WHY WOULD PEOPLE SWITCH FROM MEDICARE ADVANTAGE TO ORIGINAL MEDICARE?
Lack of Choice: Individuals with serious health issues (example, cancer) do NOT want the limitations sometimes imposed by MA plans. Even when plans allow going ‘out of network’ there can be high fees or no coverage. With Original Medicare they can see any specialist or medical facility that accepts Medicare.
Unreasonable Cost Sharing: While there may be $0 premium for your MA plan, the typical plan has a maximum out-of-pocket of between $7,000 and $10,000. Those with serious or on-going health issues face deductibles, copays and coinsurance amounts. These can be more costly than Original Medicare with a Medicare Supplement plan. For example: Hospital Stay – Average co-pay: $300 per day for the first 6 days. Radiology Services – Average co-pay: $125. Lab work services – Average co-pay: $100.
Changing from Medicare Advantage (MA) to Original Medicare is simple process. Once you are ready and eligible to switch you can:
You can change during Medicare’s Annual Enrollment Period (October 15 through December 7) and again during Open Enrollment (January 1 through March 31).
If you’re switching from Medicare Advantage to Original Medicare, you can also purchase a Medicare Supplement or Medigap policy.
Your Trial Right: During your first year in the Medicare Advantage (MA) plan, you are entitled to a risk-free trial. At any point during that first year (first time in a MA plan), you can switch back to Original Medicare without penalty.
Moving Away: When you move from your plan’s service area, you are able to re-enroll in Original Medicare without penalty. This is even if other MA are available at your new address.
Admitted to Institutional Care: If you’re admitted to any type of long-term care setting (like a nursing home), you can switch your plan up to 1-time per month during your stay. In addition to skilled nursing facilities, this includes rehabilitation and psychiatric hospitals as well as care facilities for the intellectually disabled. You can move from MA to Original Medicare for up to 2 months after you are discharged.
Covered By Medicaid: When you become eligible for Medicaid benefits, you can drop your MA plan and switch to Original Medicare. You can change once a quarter during the first 3 quarters of the year. Also during AEP.
WHY WOULD PEOPLE SWITCH THEIR MEDICARE SUPPLEMENT PLAN?
FOUR KEY REASONS: Your rate is increasing and you want a policy that costs less. You are paying for benefits you don’t need. More benefits are needed. You want to change your insurance company.
Switching Medigap policies is possible BUT NOT always. And the rules can actually vary by State. Some states have made it easier to switch.
Here are things to consider:
Different Plans Have Cheaper Premiums: The majority of people turning age 65 are now selecting Plan G coverage. To reduce the cost, there is Plan N and even High Deductible Plan G (which can be ideal for those with few medical needs).
Moving: You can keep your current Medigap policy no matter where you live as long as you still have Original Medicare. If you want to switch to a different Medigap policy, you will need to check with your current or new insurance company to see if they’ll offer you a different policy.
If you decide to switch, you may have to pay more for your new Medigap policy. You may also have to answer some medical questions if you’re buying a Medigap policy outside of your Medigap open enrollment period.
Medigap Birthday Rule: Five states offer a special Birthday Rule that can benefit individuals looking to switch their Medigap policies.
Click here to learn more about the Medigap Birthday Rule
Here’s what to do IF you want to switch. You can apply for Medicare Supplement insurance anytime. Of course, you must be enrolled in Medicare Part A and Part B. However, a plan (insurance company) does not have to accept your application, unless you have guaranteed-issue rights.
We recommend working with a Medigap insurance agent and you can click the link to access the free Medigap insurance agent online directory. Or, call the insurance company that’s selling the plan you want. After they confirm (in writing) acceptance of your application, call your current Medicare Supplement insurance company and ask how to end your current plan.
A few tips: 1. Keep your current (old) plan for the 30-day free look period described above.
2. Do everything in writing. Including cancelling your prior (former) coverage.
3. If you decide not to stay with the new plan, you can keep your old one. But once you cancel the old policy, you generally can’t get it back.
Switch Medicare Plans & More Information for Seniors
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