Senior Life Matters

Question; While out for coffee today, my friend told me that she changed her insurance and it will start the first of next month. I thought the only time you could change your insurance was in the fall. How can she switch her plan now?

Question; While out for coffee today, my friend told me that she changed her insurance and it will start the first of next month. I thought the only time you could change your insurance was in the fall. How can she switch her plan now?


Answer; How exciting to hear that people are talking about their Medicare products at gatherings!! That just makes me smile from ear to ear!

First, you are correct, most individuals change their Medicare related products during the Annual Open Enrollment Period, October 15thto December 7th. During this fall opportunity to change, any product you switch to begins January 1st.

This year we have a brand new Enrollment Period, the Medicare Advantage Open Enrollment Period (MA-OEP). This brand new opportunity runs from January 1stto March 31st. During this new MA-OEP, the rules are different (SURPRISE, Surprise!!). This Enrollment Period is available to those individuals who HAVE a Medicare Advantage Plan and would like to make a switch to another plan.

What I am excited to tell you about, is that on average, 31% of Medicare eligible individuals in New York State have Medicare Advantage Plans. In our region (Chaut/Catt Counties) is it even higher – over 41%. That means that almost half of our Medicare eligible individuals have an additional opportunity to change their insurance. I think that is great!

This MA-OEP can be used to switch from any Medicare Advantage Plan into any other type of plan you want. For example: If you have an HMO without drug coverage, you can move to a PPO with drug coverage. If you have a PPO product, you can switch to Original Medicare, add on a Medicare Supplement Plan and then decide if you want a Medicare Prescription Drug Plan. (Of course you know, I always recommend having a drug plan!). If you have a PFFS plan you can switch to an HMO plan with drug coverage. If you have an HMO with a high premium, you could switch to an HMO with $0 premium. You can switch insurance companies, or you can stay with the same insurance company.

You may notice in each example, you must HAVE a Medicare Advantage Plan (HMO, PPO or PFFS) to begin with. This enrollment period requires that you are moving from a Medicare Advantage Plan to anything else.

During this MA-OEP, any change you make during January begins February 1st, any change you make in February begins March 1st, and any change you make in March begins April 1st. This change could be quicker than the fall OEP. That shows you other differences between the MA-OEP and the fall OEP.

There are some individuals who are not eligible to use this new MA-OEP. For those with Medicare who are using their Original Medicare, plus a Medicare Supplement + a Prescription Drug Plan (PDP), this MA-OEP is not available to them.

This MA-OEP also allows you to change your decision regarding your Prescription Drug Coverage. As I said earlier, I always recommend that everyone have Prescription Drug Coverage. There are 44 plans available in Chautauqua County. There are 46 available in Cattaraugus County.

This MA-OEP gives anyone with a Medicare Advantage Plan the opportunity to change his or her Part D decision. So, if up to this point you haven’t had Prescription Drug Coverage, you could add that coverage now. Remember in adding this coverage you may have an enrollment penalty because you did not have Prescription Drug Coverage up to this point.

There also may be an individual who does not want Prescription Drug Coverage. You may be eligible for VA Services and Medical Care now, and can get your Prescriptions through the VA. In this situation, you could use this MA-OEP to switch to a plan that does not include Prescription Drug Coverage. In this case, you would have to get all your medications through the VA.

I am not saying I do not like Medicare Advantage Plans. I do not want you to conclude that I think Medicare Advantage Plans are inferior. They are NOT inferior. They are very good options for the right person. It is important to look at your situation and make sure that the plan you have, is the right plan for you. If you are feeling like your Medicare Advantage Plan may not be right for 2019, it is not too late to switch. You can switch your choice up to March 31st this year!

You may want to change plans if you have a Medicare Advantage Plan and think your premium is too high, or your medications have changed and are difficult to get, or are not covered. Also, if your medical situation has changed, such as you need knee surgery, and Physical Therapy, or are newly diagnosed with a serious illness (like Cancer), a Medicare Advantage plan may not be right for you. This MA-OEP is an opportunity to evaluate your options and make a different decision!

This MA-OEP means that the door to change is OPEN!! Use this time to evaluate your options. Don’t get stuck thinking you missed your opportunity to switch in the fall. Use this opportunity to see what is available to make your insurance fit your situation!

Good luck and Happy Medicare Advantage Open Enrollment Season!!

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