Senior Life Matters

Question: I have a Medicare Advantage Plan, but I think I made a mistake in keeping that type of plan for 2019. Could I switch it? When can I switch it? What do I do?

Question: I have a Medicare Advantage Plan, but I think I made a mistake in keeping that type of plan for 2019. Could I switch it? When can I switch it? What do I do?


Answer: Medicare Advantage Plans are plans that replace your Original Medicare Benefits and usually include prescription drug coverage. During Open Enrollment (October 15thto December 7th) you have an opportunity to re-evaluate your entire insurance package and make a new decision. That period is obviously over for now. But it will be available again in the fall for your 2020 decision.

This year we have a NEW Open Enrollment Period, which is right now. From January 1 to March 31, we have what is now called the Medicare Advantage Open Enrollment Period. 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. There are 29 Medicare Advantage plans available this year in our area. Most of them have some sort of premium in 2019. They all have different co-pay structures and networks of providers, so I will speak broadly to this situation.

The Medicare Advantage plans are the 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 to control their costs. This could be increased premiums, increased co-pays and deductibles, reduction of extra benefits, etc. You may have thought your plan didn’t change those cost structures, but now have decided you might want something different.

During this Enrollment Period, you can go from a Medicare Advantage Plan (with or without drug coverage) to a different Medicare Advantage Plan (with or without drug coverage, or Original Medicare AND a Stand-Alone Drug Plan (PDP) or Original Medicare and NO drug coverage.

The Medicare Advantage Open Enrollment Period allows you to switch your Drug Coverage status. You can change your Drug Coverage decision, meaning that you can add on Prescription Drug Coverage if you didn’t have it before, or you can drop out of Prescription Drug Coverage. I would NOT recommend dropping Prescription Drug Coverage altogether, unless you are part of that small number of people who have it from another source (like VA benefits).

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.

A couple of examples may help here: if you have an HMO plan (like Senior Choice, Encompass 65 or Senior Blue), you may switch to ANY other Medicare Advantage Plan (HMO, PPO, or PFFS) or to original Medicare with a Stand-Alone Drug Plan (23 plans available). You may switch from your PPO without Drug Coverage (like United Healthcare’s Medicare Complete Essential) to Original Medicare, a Medicare Supplement Plan and a Stand- Alone Drug Plan.

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 1stto March 31st.

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 2-1-19. If you change your insurance during February, your new plan will begin 3-1-19. If you change your insurance during March, your new plan will begin 4-1-19.

This Medicare Advantage Enrollment Period 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 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 stay with for 2019. Another reason could be that your co-pay structures are higher than you thought, which means the company changed how much services cost you to use. The last reason that people sometimes switch out of Medicare Advantage Plans is that they have a serious medical problem that may be covered more comprehensively and broadly than their Medicare Advantage Plan allows. (In this situation I am thinking about something like Cancer or Renal Failure maybe.)

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. There may be times in adding a Medicare Supplement Plan that there are pre-existing conditions limitations, but this is NOT one of those times. As long as your time without insurance is less than 63 days, the “pre-existing conditions” limitations does NOT apply. Using this scenario you are going directly from one product to another, and the “pre-existing limitations” clause does not apply to you.

This Medicare Advantage Enrollment Period is certainly one of the ways to switch your insurance for the new year. Again, this time period runs from January 1 to March 31 and will available every year!

There are other ways that you can change your insurance choice for 2019, called Special Enrollment Periods (SEP’s). In future articles I will be reviewing other Special Enrollment Periods available to you. 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.

To contact Janell Sluga, GCMC with questions or concerns, please call 716-720-9797 or e-mail her at

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