Should You Change Medicare Advantage Plans?

What you need to know when considering a change to Medicare Advantage Plans

Should you change Medicare Advantage plans?

Maybe.  We feel you should ask this question each year between October 15 AND March 31.

Why?  Because some of these plans continue add coverages at little or no cost to the plan member.  If these coverages add value to you and your choice of doctors/hospitals/other providers remains the same and the out of  pocket cost to use plan services is lower/the same as your current plan you may be better off to change plans.

If you relate to points below you may be better off if you change Medicare Advantage plans.

The points to consider are:

1. Your monthly premium is above $70 and you are concerned about your copays and ‘out of pocket limit’ rising each year.

2. You learned other plans have much lower cost for the prescription medications you take.

3.  You moved to a zero premium plan and later found out the plan only has one major hospital in it’s network and your selection of physicians is much smaller than you thought.

4. Not all of your medications are covered by your plan.

5. You learned other Medicare Advantage plans that now include preventive and comprehensive dental included in the plan’s monthly premium and yours does not.

6. Your current plan requires permission to see a specialist.  You want a plan without this requirement.

7. You know the government no longer gives insurance companies with a star rating below 4 any bonus money and are concerned your premium and copays are higher because of your plan’s 3 or 3.5 star rating.

8. Your plan will not be available next year (you will get a notice from your insurance company if this happens to you).

9. The doctors and/or hospitals you prefer are no longer in your plan’s network.

10. You did not really explore your options before enrolling in a Medicare Advantage plan. You just enrolled in a plan your neighbor, friend, or was offered by your group insurance carrier before retiring.

11. You did not know about or understand your options with the 10 different Medigap (Medicare Supplement) plans.

If this interests you, we encourage you to learn more about Medigap policies and carrier differences and then call us.

12. You didn’t understand that with Original Medicare you can use any doctor/hospital that accepts Medicare and you are feeling the network restrictions of your Medicare Advantage plan is limiting your provider choices.

13. Your Medicare Advantage plan has extra features not covered by Medicare and you are not using them. You are concerned your premium is higher because of these features.

14. You just learned about 2 Medigap plans with an out of pocket limit much lower that your Medicare Advantage plan AND these plans let you use any doctor/hospital in the US that accepts Medicare.

15. You feel it is unfair to have to be restricted on you choice of doctors and hospitals.

16.  You just learned about the article found here and are wondering if you made the right choice.

What should you do?  Should you change Medicare Advangtage plans?

Should you change Medicare Advantage plans?  If you are not sure yet, you should find the report recently published by the  Kaiser Family Foundation good reading.  This report interviewed many people concerning their feelings about this topic.  The summary of their findings is here .  CNBC also published a report dated October 7, 2014 encouraging people to shop around.  Read this report here.

We noticed some people interviewed for this report felt there isn’t anyone available to help them sort through their Medicare choices.  We feel that is unfortunate because this is exactly what we specialize in…helping people understand Medicare, review their options, explain differences in their choices, answer their questions, and if they want to change plans, help them with enrollment (we do this for Idaho residents).

Do you have a ‘trial right’?

If you joined a Medicare Advantage Plan or Programs of All-inclusive Care for the Elderly (PACE) when you were first eligible for Medicare Part A at 65, and within the first year of joining, you can switch back to Original Medicare and select a Medigap plan (and a stand-alone prescription drug plan)….and not go through ‘underwriting’.   Also, if you dropped a Medigap policy to join a Medicare Advantage Plan (or to switch to a Medicare SELECT policy) for the first time and you have been in the plan less than a year you can switch back.  Why would you do this?  To get the coverage you want.   If you are in this situation and want help, call us.

Is your Medicare Advantage plan no longer available?

Like the trial right described above, if your Medicare Advantage plan is no longer available, you may have a ‘guaranteed issue’ to enroll in a Medigap plan without going through underwriting.  Call us if you would like help comparing this option to your other Medicare Advantage plan choices.

The Idaho Medicare Advantage market

We feel the Idaho Medicare Advantage marketplace is quite competitive in some Counties.  In some Idaho Counties, people do not have a choice to the question of Should I Change Medicare Advantage Plans because none are available.  Other Counties only have plans with high premiums available.  One key point we typically see changes to plans occur annually (premiums, copays, out of pocket limits change as do networks and the prescription drug side of their plans).  New plans are announced, some plans have reduced or expanded the Counties where they do business, and some plans are just drop out of the market(s) they have been serving.  When we compare the differences between the 2018 and 2019 plans available in each county in Idaho, we strongly feel people should be paying attention and evaluate their options.  We can help you think this through.

For people on a fixed income, we feel it makes sense for them to manage their health expenses by paying attention their health plan choices annually.   People can change plans during the Medicare Annual Enrollment Period and during the new Open Enrollment Period (January 1 thru March 31).

There are other ‘special enrollment periods’ that cover unique situations too (like moving to a new plan service area).

If your other plan choices:

include your preferred medical professionals and hospitals

have out of pocket costs that are lower for the services you use such as ‘inpatient hospital daily fees’ and the number of days those fees apply, skilled nursing copays/timeframes they are applicable, Part B drugs, MRI’s/CAT scans, etc.

has a lower ‘out of pocket limit’

has lower fill/refill costs for the prescription medications you use

has non-Medicare covered services you would use

and have lower monthly premiums.

We feel the answer to the answer to the question of should you consider changing Medicare Advantage plans is yes.

We are here to help.

We are licensed with all plans available in all Idaho Counties and all of the Medigap plans too.  Feel free to learn more about us before calling.  We are on Medicare and understand the challenges and issues people have with this subject.     We are available on 208-867-0296.

This page was last modified on Apr 12, 2020 @ 10:00 AM