Medicare Advantage Plans are plans that replace your Original Medicare Benefits and usually include prescription drug coverage. There are definitely rules that dictate when and how you are allowed to switch your coverage.
Right now, from January 1 to March 31, we have what is called the Medicare Advantage Open Enrollment Period (MA-OEP). This three month opportunity is a time when any individual with a Medicare Advantage Plan can switch to any other type of insurance product they choose, with or without drug coverage.
You stated that you have a Medicare Advantage Plan (MA Plan). There are 46 MA Plans available in our area. They all have different monthly premiums, co-pay structures and networks of providers, so I will speak broadly to this situation. Most MA plans include Prescription Drug Coverage.
The Medicare Advantage Plans are health plans that replace traditional Medicare, such as HMO’s (Health Maintenance Organizations), PPO’s (Preferred Provider Organizations), and PFFS (Private Fee For Service) plans. Each year, insurance companies adjust coverage, these changes include premiums, co-pays and deductibles, extra benefits, etc. You may have thought your plan didn’t change, or now have decided you might want something different.
During this Enrollment Period, you can go from a MA Plan (with or without drug coverage) to a different MA Plan (with or without drug coverage, or Original Medicare AND a Stand-Alone Drug Plan (PDP) or Original Medicare and NO drug coverage.
It is also important to remember that if you are dropping a Medicare Advantage Plan and returning to Original Medicare, you should seriously consider adding on a Medicare Supplement Plan. So leaving your HMO, or PPO or PFFS plan could reactivate your Original Medicare, and then you would need to decide to enroll in a Drug Plan and a Medicare Supplement Plan. These two things do not happen without you actively enrolling in a product of your choice.
So if for some reason you chose NOT to get drug coverage as part of your Medicare Advantage Plan, you could change that choice from January 1 to March 31.
During this period of time, your new coverage will begin the first of the following month. If you change your choice during January, your new plan will begin February 1. If you change your insurance during February, your new plan will begin March 1. If you change your insurance during March, your new plan will begin April 1.
This MA-OEP is also useful for those individuals who are deciding that they don’t want to stay in their Medicare Advantage Plan for any reason. One reason could certainly be that your premiums or co-pays have increased. Another reason could be that your doctor, hospital, or pharmacy, no longer participate with the Medicare Advantage Plan you had thought you wanted to keep. The last reason that people sometimes switch out of MA Plans is that they have a serious medical problem that may be covered more comprehensively with Original Medicare. (In this situation I am thinking about something like Cancer or Renal Failure.)
In the event that you decide to go back to Original Medicare, I always stress the importance of evaluating the option of adding on a Medicare Supplement Plan in this situation. In New York State, you are allowed to enroll in a Medicare Supplement Plan anytime. In this situation there are no pre-existing conditions limitations. In this type of change you are going directly from one product to another, and the “pre-existing limitations” clause does not apply to you.
This MA-OEP is certainly one of the ways to switch your insurance right now from January 1 to March 31!
There are other ways that you can change your insurance choice for called Special Enrollment Periods (SEP’s). There are lots of other SEP’s and there may be one that fits your situation and would allow you to change your insurance another way throughout the year.
Senior Life Matters is a community based program sponsored by Lutheran Jamestown. For questions, concerns or to reach Janell Sluga, GCMC, call us at 716-720-9797 or e-mail at SLM@lutheran-jamestown.org.