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If you’re enrolled in a Medicare Advantage plan and you’re not happy with it, you do have annual opportunities to switch to a different plan, including Medicare Open Enrollment in the fall and the Medicare Advantage Open Enrollment Period.1 But do you need to switch?
Here are a few good reasons why it could pay to change your coverage when you have the opportunity.
One downside to Medicare Advantage is that unlike Original Medicare, it limits you to a specific network of providers. If you have a trusted doctor or facility that’s no longer considered in-network, you may want to find out if there’s an affordable alternative that allows you to continue seeing the providers who know your medical history and make you the most comfortable.
Like stand-alone Medicare Part D, all Medicare Advantage plans with integrated Part D coverage (MA-PDs) have a formulary that categorizes prescription drugs by tier. The lower the tier, the lower your out-of-pocket costs under that plan.
If a medication you take regularly has recently moved from a lower tier to a higher tier under your Advantage plan, then that could be reason enough to switch. This especially holds true if your prescriptions land you in a specialty tier – the most expensive option on the table for brand-name drugs, and, occasionally, generic drugs as well.
It could also be the case that you’ve recently been prescribed a new drug that isn’t on your plan’s formulary, or that’s in a high tier, and you’re able to find another plan that covers it with lower out-of-pocket costs.
Maybe your Medicare Advantage plan didn’t get more expensive from the previous year, or reclassify your medications so that they cost more. But that doesn’t mean there’s not a cheaper option available.
Medicare has a comprehensive Plan Finder you can use to search for Advantage plans in your area and compare them by premium and drug costs. If you find a plan with lower total premium and drug costs — and other medical coverage that’s roughly equivalent to what you have now — switching could be a huge money-saver.
One big reason so many seniors opt for Medicare Advantage over Original Medicare is to gain access to additional benefits the latter won’t cover. But if your current Advantage plan doesn’t offer the perks you’re after, you might want to consider other available plans.
Between 2021 and 2022, the number of Medicare Advantage health plans offering supplemental benefits grew in 35 out of 41 categories. By 2024, nearly all Medicare Advantage plans offered dental, vision, and hearing coverage, as well as fitness benefits.2 And many plans also offered other extra benefits, such as telehealth, over-the-counter benefits, and acupuncture coverage.
If your plan doesn’t offer extra benefits that are useful to you, finding one that does could save you money. Or you might find that the extra benefits are more robust on another plan — perhaps higher benefit limits on dental coverage, for example.
There are plenty of good reasons to move from one Medicare Advantage plan to another, so if you’re currently enrolled in an Advantage plan, you have from January 1 through March 31 each year to switch to a different plan.
Remember, too, that if you’re unhappy with your current plan but can’t find a suitable alternative, there’s always the option to switch to Original Medicare and sign up for a Part D plan. This especially holds true if you’re traveling more often than you initially anticipated, and you want the option to see a doctor anywhere in the country.
(Before switching back to Original Medicare, be sure to check whether you’re able to purchase a Medigap plan to protect yourself against Medicare’s out-of-pocket costs (Original Medicare doesn’t have an out-of-pocket spending limit for health services). Medigap enrollment is subject to medical underwriting in most states after your initial enrollment window and trial right period have ended.)
Maurie Backman has been writing professionally for well over a decade, and her coverage area runs the gamut from healthcare to personal finance to career advice. Much of her writing these days revolves around retirement and its various components and challenges, including healthcare, Medicare, Social Security, and money management.
Footnotes
Today medicareresources.org released tips to help consumers avoid costly mistakes while evaluating and selecting coverage during Medicare open enrollment.
In this edition; Medicare trust fund may be at risk due to the coronavirus; Trustees expect continued Medicare Advantage enrollment growth; Medicare Advantage home care benefit could support more beneficiaries in 2021; Social Security is allowing Americans to fax their Medicare enrollment forms; Medicare will pay more for some coronavirus lab tests; CMS is allowing freestanding hospitals in some states to bill Medicare and Medicaid; CMS allows new appeals flexibility; Medicare Advantage plans to get pay boost in 2021; CMS asks Medicare Advantage and Part D insurers not to disenroll certain members
Reasons to consider a change to your Medicare prescription drug coverage may include high premiums, changes to your prescriptions or your plan's formulary, and your access to in-network pharmacies.
Enrollment dates for Medicare are critical. Missing an enrollment date could cost you higher premiums down the line — or it could cost you coverage entirely.
If you shun private coverage, can you get by on Original Medicare without purchasing supplemental coverage (Medigap and Part D prescription coverage) or using a Medicare Advantage plan?
Today medicareresources.org released tips to help consumers avoid costly mistakes while evaluating and selecting coverage during Medicare open enrollment.
In this edition; Medicare trust fund may be at risk due to the coronavirus; Trustees expect continued Medicare Advantage enrollment growth; Medicare Advantage home care benefit could support more beneficiaries in 2021; Social Security is allowing Americans to fax their Medicare enrollment forms; Medicare will pay more for some coronavirus lab tests; CMS is allowing freestanding hospitals in some states to bill Medicare and Medicaid; CMS allows new appeals flexibility; Medicare Advantage plans to get pay boost in 2021; CMS asks Medicare Advantage and Part D insurers not to disenroll certain members
Reasons to consider a change to your Medicare prescription drug coverage may include high premiums, changes to your prescriptions or your plan's formulary, and your access to in-network pharmacies.
Enrollment dates for Medicare are critical. Missing an enrollment date could cost you higher premiums down the line — or it could cost you coverage entirely.
If you shun private coverage, can you get by on Original Medicare without purchasing supplemental coverage (Medigap and Part D prescription coverage) or using a Medicare Advantage plan?
