If you’re unhappy with your current Medicare plan or are just interested to see if there’s a better or more affordable plan that would work for you, all enrollees do have one opportunity each year to change plans. It’s called the Annual Enrollment Period (AEP) and in 2018, that period will take place between Oct. 15 to Dec. 7, with plans starting Jan. 1, 2019. There are many factors that could affect your costs each year, so you should consider shopping for plans during AEP. For example, changes in your income or financial situation could impact your monthly premium. Insurance companies could also increase premiums or change how much they contribute for different benefits.
Should I change plans?
Here are several reasons you may want to consider changing your Medicare plan during AEP:
- Your prescriptions have changed in any way. For example, if you’re on any new prescriptions, switched from brand name to generic, or from one drug to another. If you’re taking a new drug not included in your current plan’s formulary, you’ll want to move to a plan that covers all of your current prescriptions. Additionally, drug costs can and often do change from year to year. It’s always smart to double check that your plan works with your drugs. For more information on how Medicare Part D drug costs are determined throughout the year, visit this article.
- You’re planning to undergo a surgical procedure in the upcoming year and want additional coverage through a Medicare supplement plan.
- You need dental, hearing, or vision coverage and don’t have it on your current plan.
- A particular benefit is no longer beneficial or necessary. You may be able to find a cheaper plan without it.
- You want a plan with the wellness benefit created as a result of the Affordable Care Act.
- Your premium has gone up or you can get similar coverage for a lower premium on another plan.
- You can’t afford or don’t want to pay a high deductible. Many plans offer a low or $0 deductible in exchange for a higher premium.
- Your current plan has changed or removed some of its benefits.
- You plan to move, travel, or live somewhere else for part of the year. Many Medicare Advantage plans charge more or don’t cover out-of-network care.
- You change doctors and they aren’t in your current plan’s network.
One potential pitfall
There are some instances where you may face penalties for switching plans, even during AEP. For example, if you try to change from a Medicare Advantage plan to a Medicare Supplement plan, you may be subject to medical underwriting. This means the new plan can deny you coverage or charge a higher premium based on your age, gender, and health.
Know your rights
If you find yourself in any of the following situations, you have the guaranteed-issue right to buy a Medicare Supplement policy outside of your Open Enrollment Period:
- You have a Medicare Advantage plan, but your provider has left the service area.
- You have moved out of your plan’s service area.
- Your employer coverage is ending (and you currently have Original Medicare).
- You have a Medicare SELECT plan, in addition to Original Medicare coverage, and you have moved out of the plan’s service area.
- The insurance company that provided your Medicare Supplement insurance went bankrupt.
- You elected to end your Medigap coverage because your insurance company was not compliant with the law or misled you.
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How do I make the switch?
If you are joining a Medicare Advantage plan for the first time from Original Medicare or switching from one Medicare Advantage plan to another, making the change official is fairly straightforward. You will simply join the new plan during Open Enrollment. When your new coverage goes into effect, you will be automatically disenrolled from your old plan. It’s really that easy.
If you want to switch from a Medicare Advantage plan to Original Medicare, you can only do so if you joined this plan during your initial enrollment period. This must also be your first year in that same plan. Assuming you meet both of these criteria, you will need to get in touch with your current insurance provider. You can also call Medicare at 1-800-MEDICARE.
If you are thinking about switching from a Medicare Advantage plan to a Supplement plan, you’ll need to disenroll from your Medicare Advantage plan during one of the approved periods (the Annual Enrollment or Disenrollment Period). You’ll also need to apply to a Medicare Supplement plan, which can include underwriting. Because you can potentially be rejected from a Medicare Supplement plan, we recommend submitting your application before disenrolling from your current plan.
If you are already enrolled in a Medicare Supplement, but you want to switch to a different type of Medigap policy, the process can be a bit tricky. Because Medigap insurance has no annual open enrollment periods, most experts suggest to purchase the most comprehensive Medigap policy you can afford during the “Medigap open enrollment” period. This period spans the first six months after enrolling for Medicare Part B. This is the only time period in which you are guaranteed to be accepted by whichever Medigap policy you choose without the fear of higher premiums or outright rejection.
It is possible to change from one Medigap policy to another at a later date. However, Medigap carriers will then be allowed to raise your premiums based on your age, health, or pre-existing conditions. They are also within their rights to refuse to sell you coverage altogether. If you do find yourself in this position, you will need to contact carriers directly to apply for the new policy.