courtesy of NAELAeBulletin:
by Sarah O’Brien
- You can only make one change during the current three-month window, which makes it important to be aware of any potential snags or restrictions you may encounter.
- Of Medicare’s 61 million or so beneficiaries, roughly 38% (23 million) choose to get their coverage through an Advantage Plan.
- Separately, if you missed your initial Medicare enrollment period and don’t qualify for an exclusion, you can sign up through March 31.
If your 2020 Medicare coverage includes an Advantage Plan that’s not a great match, you might be able to part ways with it.
During an enrollment window that opened Jan. 1 and closes March 31, you can swap your plan for another or drop it and return to basic Medicare (Part A hospital coverage and Part B outpatient coverage). Yet, before you make a change, be sure you’re aware of potential snags and any restrictions involved.
“Do your due diligence before you switch, because if you make another mistake in your choice, you’ll be stuck with it for the rest of the year,” said Danielle Roberts, co-founder of insurance firm Boomer Benefits in Fort Worth, Texas.
Also possible through March 31: If you missed your initial Medicare enrollment period and don’t qualify for an exception, you can sign up now. If this is your situation, coverage won’t start until July 1, said Elizabeth Gavino, founder of Lewin & Gavino in New York and an independent broker and general agent for Medicare plans.
Of Medicare’s 61 million or so beneficiaries, more than a third choose to go with an Advantage Plan, which delivers Parts A and B and usually Part D prescription drug coverage, along with extras such as dental and vision. While most recipients tend not to change their plan, experts generally agree that evaluating whether there’s a more cost-effective option should be a yearly process.
The current three-month opportunity to change or drop your Advantage Plan comes just a few weeks after the close of Medicare’s annual fall open enrollment, when a variety of options were available for those who wanted to make changes to their coverage.
For this current period, however, there are restrictions.
For starters, you can only switch once. This means that once you move to a different Advantage Plan or drop it for basic Medicare, the change is locked in for 2020 (unless you meet an exclusion that qualifies you for a special enrollment period).
Additionally, this three-month window does not allow you to switch from one stand-alone Part D prescription drug plan to another.
If you picked a Part D plan in the fall open enrollment period based on faulty or misleading information, you can call 1-800-Medicare at any point during the year to see if your situation would allow you to make a change.
Meanwhile, dropping an Advantage Plan in favor of basic Medicare typically means losing prescription drug coverage — which means you would have to enroll in a stand-alone Part D plan. This matters, because if you go 63 days without the coverage, you could face a lifelong penalty that gets tacked on to your premiums.
Also, if you switch back to original Medicare and want to get a supplemental policy (also called Medigap), you may not get guaranteed coverage, depending on various factors that include where you live and exactly how long you’ve had your Advantage Plan. These policies either fully or partially cover cost-sharing of some aspects of parts A and B, including deductibles, copays and coinsurance.
“You might have to go through medical underwriting and answer health questions from the insurer and you might not get coverage,” said Gavino, of Lewin & Gavino.
If you’ll be subject to a health check, be sure to apply for the supplement before you drop your Advantage Plan.
“The worst-case scenario is that you go back to original Medicare and then no company takes you for Medigap, and you’re stuck for the rest of the year,” said Roberts, of Boomer Benefits. “So the order of events is really important.”
If you want to switch to a different Advantage Plan, your options largely depend on where you live.
The average Medicare beneficiary has 28 plans available to them this year, up from 24 in 2019, according to the Kaiser Family Foundation. However, 77 counties — generally in rural areas — have no Advantage Plan available.
If you want to switch to a different Advantage Plan, remember to make sure your doctors and other providers are in-network, Roberts said. And, assuming the plan includes Part D prescription drug coverage (most do), be sure that any medications you take are covered.