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How to Change Medicare Plans
By Kolt Legette
Since 2003, Kolt Legette has helped clients navigate the often-confusing world of insurance. His number one goal is protecting the medical and financial wellbeing of every person he speaks with, wheth ... sceler they choose to buy insurance or not. Kolt loves representing the best brands in medical insurance as it allows him to provide side-by-side comparisons for his clients. This allows the client to decide which company works best for them. By putting the needs of the client above everything else, Kolt helps real people find affordable health insurance solutions for their most pressing healthcare needs. With his belief that peace of mind is priceless, Kolt's goal in every interaction is to make sure every person he speaks to leaves with the peace of mind they rightfully deserveRead more
Apr 12, 2021
Original Medicare Part A (hospital insurance) and Part B (medical insurance) are offered by the federal government and you can enroll when you turn 65 years old or have a qualifying disability.
However, there are other ways you can receive Medicare benefits, such as Part D prescription drug coverage, Medicare Supplement (Medigap) plans, and Medicare Advantage (Part C) plans. These are offered by private insurance companies who are contracted with Medicare.
Depending on which way you receive benefits, you may find you want or need to switch plans at some point of the year. This could be switching from one plan to another, changing back to Original Medicare, or getting different coverage.
So how do you change Medicare plans? When are you able to do so? And what are the things you should consider prior to changing plans? Read to learn more.
Yes, you can change Medicare plans and how you receive coverage if you decide your existing coverage isn’t right for you. There are a number of reasons you may want to change plans, such as different coverage, costs, provider networks, or prescription drug coverage.
However, there are only a few times during the year when you’re able to enroll in other plans, so you’ll want to be aware of that when deciding what to do. See below in How to change Medicare plans during enrollment periods.
If you go back to Original Medicare from a Medicare Advantage plan that had Part D coverage, you’ll have to enroll in a stand-alone prescription drug Part D plan. While Part D coverage is optional, you cannot go for more than 63 days without creditable drug coverage. Otherwise, you’ll have to pay a premium penalty.
If you don’t already have Part D coverage, simply enroll with the plan directly. If you have Part D coverage and want to switch to a new plan, enroll with the new plan and your old coverage will end when your new coverage begins.
Medicare Supplement, or Medigap, plans can be a consideration depending on when you make changes to your Original Medicare coverage.
When switching from another plan back to Original Medicare, you can choose to enroll in a Medigap plan to help cover some of the costs and fill the “gaps” that Medicare doesn’t pay or cover.
If you already have a Medigap plan with Original Medicare but would like to enroll in a Medicare Advantage plan, you will have to drop your Medigap plan because the two cannot be used together. Vice versa, if you have a Medicare Advantage plan but would like to return to Original Medicare with a Medigap plan, you must disenroll from your MA plan in order to enroll in Medigap.
To enroll or disenroll from a plan, contact your plan directly.
If you want to join a Medicare Advantage plan and you have Original Medicare, you simply need to sign up for the new plan. You do not need to tell Medicare you’re changing plans.
If you’re already enrolled and want to switch, you have two options:
- Switch to a new Medicare Advantage plan. To do this, join the plan during one of the enrollment periods and you’ll be automatically disenrolled from your old plan once your new coverage begins.
- Switch to Original Medicare. Contact your current plan, or call Medicare directly. If you don’t enroll in another Medicare Advantage plan, you often have to notify your plan in writing that you want to disenroll.
If you have other coverage, in some cases joining an MA plan could cause you to lose employer or union coverage, for yourself and for any spouse or dependents. However, depending on your coverage, you may be able to still use your employer or union coverage as well as enroll in an MA plan.
If you have other medical coverage, be sure to talk to your employer, union rep or other benefits administrator before joining a Medicare Advantage plan to understand your coverage/plan’s rules. If you drop employer or union coverage, you may not be able to get it back, so ensure you’re making the right decision by knowing all of the information.
There are three primary periods of time when you can join, switch or drop a Medicare health plan or Medicare Advantage plan:
- Initial Enrollment Period. This is when you first become eligible for Medicare. It includes the three months before the month you turn 65, the month you turn 65, and the three months following the month you turn 65. You can join any plan at this time.
- Open Enrollment Period. From October 15 through December 7 each year, you can join, switch or drop plan coverage. The coverage from your new plan will start January 1. Specifically, you can:
- Change from Original Medicare to a MA plan
- Change from an MA plan to Original Medicare
- Switch from one MA plan to another MA plan (with or without drug coverage)
- Join a Medicare drug plan
- Switch from one Medicare drug plan to another
- Drop your Medicare coverage completely
- Medicare Advantage Open Enrollment Period. From January 1 through March 31 each year, if you’re enrolled in an MA plan, you can switch to a different MA plan or switch back to Original Medicare. Specifically, you can:
- Switch from one MA plan to another MA plan (with or without drug coverage)
- Drop MA coverage and return to Original Medicare
- Switch from Original Medicare to an MA plan
- Join a Medicare drug plan if you’re in Original Medicare
- Switch from one Medicare drug plan to another (if you’re in Original Medicare)
Additionally, you could qualify for a Special Enrollment Period (SEP), which allows you to change your coverage outside of normal enrollment periods. There are specific circumstances you must meet in order to qualify for an SEP, such as moving out of your current plan’s service area.
Medicare’s Annual Enrollment Period, or AEP, is interchangeable with the Open Enrollment Period. During this time, which is October 15 through December 7, you can join, switch or drop plan coverage with new coverage beginning January 1.
There are three primary parts of Original Medicare: Part A, Part B and Part D. These parts give you the coverage you need for hospital and medical services and equipment, as well as prescription drug coverage.
When you apply for Medicare, you are automatically enrolled in Part A, which covers:
● Inpatient hospital care (including any tests, treatments or surgeries you need while admitted in the hospital)
● Skilled nursing facility care (short-term)
● Nursing home care.
● Hospice care.
● Home health care
Part B covers medically necessary services or supplies that are needed to diagnose or treat a medical condition, as well as preventive services to help keep you healthy.
● Doctors' visits
● Outpatient care, such as emergency room services and same-day surgical procedures
● Lab tests and services
● Diagnostic imaging
● Therapy (physical, occupational, speech-language)
● Diabetes supplies
● Clinical research
● Ambulance services
● Durable medical equipment (DME)
● Mental health services (both inpatient and outpatient)
● Certain prescription medications
● Chemotherapy and radiation
● Annual preventive screenings
Part D covers most outpatient prescription drugs. This coverage is offered through private companies as either a stand-alone plan you purchase separately, or as an included benefit with your Medicare Advantage plan.
Part D also covers most vaccines, other than those covered by Part B.
Other than Original Medicare Part A and Part B, there are additional ways you can choose to receive Medicare coverage and benefits. These are called Medicare health plans.
Typically, these plans:
● Are offered by a private insurance company.
● Contract with Medicare to provide both Part A and Part B benefits
● Provide these benefits to people with Medicare who also are enrolled in the plan
Medicare health plans include:
● Medicare Advantage plans
● Medicare Cost Plans
● Demonstrations/Pilot programs
● Programs of All-inclusive Care for the Elderly (PACE)
● Are the medical services and supplies you need covered by the plan?
● Do you have other coverage already that needs to be taken into consideration, such as employer coverage, Medicare Advantage plan coverage, or Part D prescription drug coverage?
● What are the costs associated with the plan, such as premiums, deductibles, copays/coinsurance and other costs? Are there out-of-pocket limits? How much do you pay for services you may use more often, such as doctor visits?
● Do your current doctors accept the plan’s coverage? Are you willing to change doctors to ensure you’re seeing someone in the plan’s network?
● Do you currently take any prescription drugs? Do you need to join a separate Part D plan, or is Part D coverage included in another plan (like an MA plan)? Are there coverage rules that apply to your prescriptions? What are the prescription costs?
● Do you plan to travel often, either in or outside of the U.S.?
To enroll in Original Medicare, you can:
● Apply online at www.ssa.gov.
● Call Social Security.
● Call the RRB (if you worked for a railroad).
● If you already have Part A and want Part B, you must complete an Application for Enrollment in Part B.
Please note that in-person enrollment is still suspended due to the COVID-19 pandemic. As of May 2021, there is no word yet on when local Social Security offices will reopen.
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