Every fall, from October 15 to December 7, Medicare beneficiaries are given the opportunity to change their insurance plan. Most people are happy with their current plan, and approximately 90% do not move to a different insurer. However, in some cases, they may actually be missing out on the opportunity to save money and/or improve their Medicare experience.
Whether you are completely satisfied with your current Medicare insurance coverage or you think you might want to investigate other opportunities, there are a few situations when AARP recommends that consumers should at least check out their other choices and possibly make a change.
However, before you make ANY change, it is important for people who are currently on a Medicare Advantage Plan (such as Kaiser Permanente Senior Advantage) to understand that they should not switch back to original Medicare unless they have been accepted by the Medigap plan they want.
Medigap insurers are allowed to turn you down or charge you more for preexisting conditions, if you have been on Medicare Part B for at least six months, with or without a different insurer. Do not make a change in haste until you are sure you will be accepted by a new company at a reasonable price.
Everyone should also consider reading the highly rated book "10 Costly Medicare Mistakes You Cannot Afford to Make." (Ad) It could save you a lot of money in the future, and was written by a Medicare agent who is licensed in nearly every U.S. state.
After taking all that into consideration, now you need to look at the reasons why you might want to change your current Medicare policy to a new one.
Why You Might Want to Change Your Medicare Plan
1. If you have seen a sharp increase in your prescription drugs. In this case, if you are on Original Medicare, plus Medigap and a drug plan, you may want to investigate other Part D drug plans to see if there is one with a formulary which will cover your drugs at a lower price. Your pharmacist may be able to help you choose the one that covers most of your prescriptions at the lowest price.
2. If you have cancer or need surgery and you want to use a physician or surgeon who is not part of your Medicare Advantage or HMO network. Switching your policy may be the best policy, especially if you need highly specialized care.
3. If you have a serious chronic condition, and you are not sure your current plan offers the best type of treatment for you. This sometimes happens to people who are on Original Medicare, but never chose a Medigap plan. In this case, you may want to see if you qualify for a Medigap plan which will offer the care you need, or you might want to see if there is a Medicare Advantage plan in your area which will offer a comprehensive treatment for your medical condition no additional premium, above the cost of Original Medicare. Switching to a Medicare Advantage plan or adding a reasonably priced Medigap plan, instead of paying out-of-pocket, could save you a lot of money.
4. If your former employer changes its retiree health benefits, you may be required to choose a different Medigap policy. If this happens to you, you can call the Medicare Benefits Coordination & Recovery Center at (855) 798-2627. They can help you get accepted by a different Medigap carrier without paying a penalty based on a preexisting condition. This phone call could save you thousands of dollars a year in unnecessarily higher premiums, if you are forced to make a change through no fault of your own.
5. If you spend part of the year living in different states, your Medicare Advantage plan may not work in both places. This could force you to have to see out-of-network doctors in one of the states, especially if you have a serious or chronic illness. If you cannot find a Medicare Advantage plan which works in both states, you may need to go back to Original Medicare, plus get a nationally accepted Medigap plan and Part D drug plan. You will want to shop around to find the plan which will meet your medical needs and allow you to see doctors in each of the states where you reside.
6. If your income has dropped during retirement, you might discover that most Medicare Advantage plans are less expensive than Original Medicare, plus a Medigap plan, plus a Part D drug plan. Whether you have Original Medicare or a Medicare Advantage plan, you will pay the same basic monthly premium for your Medicare coverage. However, most Medicare Advantage plans charge very little in additional premiums, and sometimes nothing at all. On the other hand, people with Original Medicare usually also need a Medigap plan plus a Part D drug plan, and there will be additional monthly premiums for those. If you are trying to save money during retirement, finding a good, low-cost Medicare Advantage plan in your area may save you thousands of dollars a year in additional premiums.
7. If you really want to keep your current doctor, and he changes to a different Medicare plan, then you may want to change plans, too. However, even if you have a good reason to change, do not forget that if you are switching to a new Medigap plan, you can be denied coverage or be required to pay higher premiums for any preexisting conditions. Do not make the change until you are sure you will be accepted by the new Medigap plan at a price which is acceptable to you.
Currently, about 42% of Medicare beneficiaries use a Medicare Advantage plan, with the percentage increasing every year. However, as you can see, there is no one choice which is right for everyone. When you first sign up for Medicare, it is important that you consider the advantages and disadvantages of a Medicare Advantage plan vs. getting Original Medicare, plus a Medigap plan and a Part D drug plan. In addition, each fall you should reexamine your choice and make sure it is still meeting your needs.
You may also want to read the other post on this blog: "Medicare Supplements vs. Medicare Advantage Plans - What are the Differences?" It will also help you clarify your decision about which system of obtaining your Medicare benefits will be the best for you.
Source of facts: AARP Bulletin, October 2021
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