CDISNM Blog
Sometimes, even when you think you’ve made the right choice in a Medicare Advantage plan (Part C), you need to make changes. Whether it’s because you’re moving out of your plan’s service area, or you simply want to change plans or return to Original Medicare, there are rules for when and how you can adjust your Part C coverage. While Annual Enrollment in the fall is typically the time when most seniors make changes, there are other times throughout the year when you can change your Medicare Advantage plan.
Annual Enrollment (October 15 – December 7)
Annual Enrollment extends from October 15 to December 7 each year and is the best time to make changes to an existing Medicare Advantage plan. During this time, you can add, drop, or switch Medicare Part C plans without any penalty or restrictions. You can also join or drop a Medicare Prescription Drug Plan, or switch from one Medicare drug plan to another during Annual Enrollment. All changes you make during Annual Enrollment will become effective on January 1. All Medicare beneficiaries are allowed to make changes to their coverage during this time. Some people join Medicare Advantage or enroll in a prescription drug plan for the first time. Even if you are satisfied with your plan, Annual Enrollment is the time to look at other options in your area to make sure all of your needs will continue to be met the following year. If you are currently enrolled in a Medicare Supplement plan, you can make changes anytime throughout the year, and you are not restricted to the Annual Enrollment period. However, underwriting may apply.
Open Enrollment Period (January 1 – March 31)
If you’re interested in dropping your current Medicare Advantage Plan to return to Original Medicare, a specific period has been created for you to do so. The Open Enrollment Period extends from January 1 through March 31. This is the time for you to drop Medicare Advantage and return to Original Medicare plus a Part D Plan or change from one Medicare Advantage Plan to another Medicare Advantage Plan. All changes made during this period will be effective on the first day of the following month. For example, if you drop your Part C plan on January 22, your new coverage will begin on February 1.
Other Reasons to Change
What happens if you need to make changes to your Medicare Advantage plan outside of the Annual Enrollment or the Medicare Open Enrollment Period? Special Enrollment periods were created for people who need to make changes to Part C at other times throughout the year. For example, if you move out of your current plan’s service area or your plan leaves your area, you can switch to another Part C plan or return to Original Medicare at any time during the year. New coverage typically begins the first day of the month after you disenroll from a previous Medicare Advantage plan.
Another qualifying reason to use the Special Enrollment Period is if you want to join a 5-star Medicare Advantage plan. You may switch from your current Part C plan and join a new plan at any time during the year if the new plan has an overall performance rating of 5 stars. Note: you may only use this Special Enrollment option once during the year.
References:
Switching from Medicare Advantage to Original Medicare https://www.medicareinteractive.org/get-answers/overview-of-medicare-health-coverage-options/changing-medicare-health-coverage/switching-from-a-medicare-advantage-plan-to-original-medicare
Medicare Advantage Disenrollment https://www.medicare.gov/sign-up-change-plans/when-can-i-join-a-health-or-drug-plan/when-can-i-join-a-health-or-drug-plan.html#collapse-3192
5-star enrollment period https://www.medicare.gov/sign-up-change-plans/when-can-i-join-a-health-or-drug-plan/five-star-enrollment/5-star-enrollment-period.html
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CDISNM Blog
Medicare Annual Enrollment begins October 15 and runs through December 7. This is your time to review your current health plan, and maybe even select a new plan. Whether you’re looking to sign up for Medicare Advantage or Prescription Drug coverage, make changes to an existing plan, or dis-enroll completely, this is the time it happens. Annual Enrollment can be confusing, and many seniors do nothing at all. But, it’s well-known that both the terms and costs of plans change from year to year. Even if you’re satisfied with your existing plan, reviewing your coverage annually is smart—not only to stay informed but also, because you may be able to save money and improve your coverage with a new plan.
Remember, you only have a few choices:
If you have Original Medicare, you can choose to buy a Medicare Supplement plan (Medigap).
If you have Original Medicare you can choose to buy a Medicare Advantage plan.
If you have a Medicare Advantage plan, you can pick a new one.
If you have prescription drug coverage, you can change your Part D Prescription plan.
You should receive an Annual Notice of Change in the mail, informing you of any changes being made to your current plan’s coverage and costs for the following year. Take a minute and review this document. Then ask yourself the following four questions to ensure you are well prepared for Open Enrollment.
Was I satisfied with my health coverage last year? Before doing anything else, ask yourself if you were happy with your Medicare health plan last year. If the answer is yes, then review your Annual Notice of Change for changes in terms, coverage, or cost that may affect you this year. If your healthcare needs have changed, your existing plan may not fit your needs anymore, and it may be time to look for different coverage.
Is my doctor still in the network? Often, health plans make changes to networks from year to year. Be informed and prepared by looking to make sure your doctor and hospital are still in your plan’s network for the upcoming year. Did the terms change? For instance, do you need a referral to see a specialist?
Will I be taking any different prescriptions? As your healthcare needs change, so may your prescriptions. If you have prescription drug coverage, either as a standalone plan or through a Medicare Advantage plan, you must look for changes in the plan’s formulary. Are the medications you currently take still covered? Can you use the same pharmacy you use to pick up your medicine?
Will my out-of-pocket expenses change? Think about how much money you spent on health care last year. In many cases, if your plan doesn’t meet your needs, picking a new one may save you money. How much will your current plan expect you to pay? Has this amount increased from last year? If so, by how much? Don’t forget to look for changes in deductibles copayments and coinsurance.
Remember, it’s okay to do nothing at all when Annual Enrollment arrives. If you are happy with your current plan, it will roll over—with any current changes intact—and continue for another year.
References:
https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/questions-when-looking-for-a-plan.html
https://www.medicare.gov/sign-up-change-plans/when-can-i-join-a-health-or-drug-plan/when-can-i-join-a-health-or-drug-plan.html#collapse-3190
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CDISNM Blog
Understanding the ins and outs of Medicare Supplement insurance can be challenging. So, we decided to put together a list of the top ten most asked questions about coverage. If you need a quick refresher, or you’re simply looking for an answer, you may find it here.
1: Do I have to buy Medicare Supplement insurance to keep my Original Medicare?
A: No. Medicare Supplement insurance is optional insurance designed to help pay for some of the out-of-pocket expenses associated with Medicare, like deductibles, coinsurance, and copays.
2: Can I Combine Medicare Supplement with a Medicare Advantage Plan?
A: Unfortunately, no. It would be nice to combine the extra benefits of an MA plan with the cost-saving benefits of Medigap. However, it is not allowed. It is against the law for private insurers to sell you a Medigap plan if they know you have Medicare Advantage.
3: If I have Part A, but choose to delay Part B, can I still purchase Medicare Supplement insurance?
A: No. You must have both Part A and Part B coverage (Original Medicare) to be eligible for Medigap.
4: Does Medigap cover both my spouse and me?
A: No. Medigap covers one individual at a time. If both you and your spouse wish to have Medicare Supplement coverage, you each need to have your plan.
5: Can my Medigap policy be canceled if my health deteriorates?
A: No. Standardized Medigap policies are “guaranteed renewable”. That means that even if your health deteriorates, as long as your premiums are paid on time, you cannot be forced out of your policy.
6: Do any Medicare Supplement plans include prescription drug benefits?
A: No. In the past, some Medigap policies included drug coverage. However, policies sold after Jan 2006 do not.
7: When should I enroll in Medicare Supplement?
A: The best time to buy a Medigap policy is when you are first eligible, during your Open Enrollment period. This is a 6-month period of time that begins the month you turn 65 and enroll in Part B. If you wait until after your enrollment period, you may not be able to buy a policy, or it could end up costing you more.
8: Medicare Supplement policies are “standardized”. What does that mean?
A: All Medigap policies must follow federal laws. Standardized plans, named for letters of the alphabet, must offer the same basic benefits, regardless of who sells them. For example, a Plan “F” at one company must include the same basic benefits as a Plan “F” at another company.
9: How much does Medicare supplement insurance cost?
A: Cost varies significantly, and insurance companies often charge different premiums for the same policy. The key to getting a good rate is to compare the same policies at a few different companies. Premiums differ between plans, but some states offer the Medicare SELECT option as a way to save money—you agree to use doctors and hospitals in the network in exchange for a reduced premium.
10: What if I travel outside of the country?
A: Plans G, and N include foreign travel emergency benefits. Medigap pays 80 percent of medically necessary emergency care outside the U.S. after you pay a $250 deductible. If you purchased Plan E, H, I, or J before June 1, 2010, you also have coverage.
References:
https://www.medicare.gov/supplement-other-insurance/medigap/whats-medigap.html
https://www.medicare.gov/supplement-other-insurance/when-can-i-buy-medigap/when-can-i-buy-medigap.html
https://www.medicare.gov/supplement-other-insurance/medigap/costs/medigap-plan-costs.html
https://www.medicare.gov/supplement-other-insurance/medigap-and-travel/medigap-and-travel.html
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CDISNM Blog
Almost a third of Medicare beneficiaries receive their coverage through Medicare Advantage (MA), also called Part C. If you enroll in an MA plan, you still have Original Medicare, and you’re still responsible for paying your Part B premium. But there are other costs to consider too, such as deductibles, copayments, and maybe even a monthly premium for your MA plan. If you’re considering your options and would like an idea of what to expect for Medicare Advantage plan costs, here’s a quick breakdown.
Some Plans Charge a Monthly Premium
Luckily, there are many plans to choose from, with just as many premium amounts. Some plans offer low, even zero monthly premiums for coverage, while others can charge as much as $150 per month. Generally, with Medicare Advantage, you still need to pay your Part B premium in addition to any premium amount charged by your MA plan.
Deductibles, Coinsurance and Copays
Out-of-pocket costs vary with Medicare Advantage. Some plans require that you pay a deductible for doctor or hospital visits, while others do not. However, most plans do charge you a copayment each time you visit the doctor. This is in place of the 20 percent coinsurance you would be required to pay under Original Medicare. The good news is, that all Medicare Advantage plans are required by law to put a limit on the amount of money you will need to spend out-of-pocket for deductibles and copays for coverage each year.
Out of Network Charges
Unlike Original Medicare where you can receive care in any facility that accepts Medicare, with an MA plan, there are specific networks of providers. As a member of the plan, you agree to use the hospitals, doctors, and pharmacies that are in the plan’s network for your care. You can use providers who are not in the plan’s network or service area but it will cost you more. It’s important to read and understand your plan’s rules. If you don’t, you may be responsible for the full costs of medical services.
In Summary
Your out-of-pocket costs for Medicare Advantage are based on answers to the following questions:
How much is the plan’s monthly premium?
Does the plan pay for any of your Part B premiums?
Is there a yearly deductible?
How much will you have to pay for each visit or service? (copays and coinsurance)
Will you pay more for care received out of the plan’s network?
What is the plan’s yearly limit for out-of-pocket costs for all medical services?
References:
https://www.medicare.gov/your-medicare-costs/medicare-health-plan-costs/costs-for-medicare-advantage-plans.html
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CDISNM Blog
There are many reasons why you may want to switch your current Medicare Supplement Plan. Maybe you’re paying for benefits you don’t need, or, you need more benefits now than when you first joined. Sometimes, you need to change insurance companies or you simply want a less expensive commitment.
Know When You Can Switch
Regardless if you’ve already decided to switch your policy, you can’t unless certain conditions apply. To switch your Medicare Supplement insurance policy, you must:
Have a guaranteed issue right or be eligible under a specific circumstance OR
Be within your Medicare Supplement insurance open enrollment period
Your unique open enrollment period lasts for six months, starting when you first sign up for Part B and are at least 65 years old. During this time, you have a guaranteed issue right to buy any Medicare Supplement policy sold in your state without being turned down or being charged more because of a pre-existing health condition. If you already have a policy and you are within your six-month open enrollment period, you can switch to another plan without any restrictions. As soon as your open enrollment period ends, your guaranteed issue ends too, and you may not be able to buy another policy. If you have health concerns, be sure to pay close attention to these dates. Your enrollment period is the best time to buy or switch if you are dissatisfied with your current plan.
Guaranteed Issue Rights
There are some exceptions to the rule and other times when you may have a guaranteed issue right to buy or switch a Medicare Supplement insurance policy outside of your open enrollment period. For instance, if your current plan misleads you or isn’t compliant with the law, you can usually switch policies with no restriction. Or, if the insurance company providing your plan declares bankruptcy, you can switch to a new Medicare Supplement insurance policy. In some cases, if you drop a Medicare Supplement insurance policy to buy a Medicare Advantage plan, but don’t like it, you have up to a year to switch back to a Medicare Supplement insurance policy with a guaranteed issue right.
You Can Take a “Free Look”
You have 30 days to decide if you want to keep a new Medicare Supplement insurance policy. This “free look” period starts when you first get your new policy and ends 30 days later. If you wish to exercise your free look, do not cancel your old policy until you are certain you want to keep the new one. You will be responsible for paying both premiums for one month if you choose to take a free look.
Compare Your Old Policy With Your New Policy
Medicare Supplement insurance policies have changed significantly in the past few years. Policies sold before January 1, 2006, included prescription drug benefits. New policies do not. Some plans are no longer offered at all. If you have an older policy and you are looking to switch, know that you may not be able to carry these benefits over to a new policy. There may also be new benefits that may not have been available when you first purchased Medicare Supplement insurance. For example, many new policies are guaranteed renewable or offer lower premiums for similar coverage. Be sure to look closely at benefits and costs if you are looking to switch your Medicare Supplement insurance. Note: if you have an older policy that is no longer available and you decide to cancel it, you cannot get it back.
References:
https://www.medicare.gov/supplement-other-insurance/when-can-i-buy-medigap/switching-plans/switch-medigap-.html
https://www.medicare.gov/supplement-other-insurance/when-can-i-buy-medigap/guaranteed-issue-rights-scenarios.html
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