Can I switch Medicare Advantage plans?
A person can switch their Medicare Advantage plan at specific enrollment periods during the year. Special circumstances may allow changes outside those enrollment periods.
When a person enrolls in a Medicare Advantage plan, they do not have to stay with that plan for the rest of their life. A person may choose to switch plans if they are unhappy with the coverage or if specific circumstances in their life change that may make a different plan more suitable.
This article examines Advantage plans and discusses how and when a person can switch between plans. It also discusses eligibility and costs.
Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
What is Medicare Advantage?
Medicare Advantage is an alternative to Original Medicare. According to the Kaiser Family Foundation (KFF), in 2023, 51% Medicare enrollees had Advantage plans.
Original Medicare is federally managed health insurance for adults 65 and older and younger adults with disabilities. It includes Part A and Part B, which cover hospital inpatient care and outpatient services. Benefits are the same for any individual who enrolls, regardless of preexisting health conditions.
Private insurance companies offer Medicare Advantage plans. The federal government sets the guidelines and rules, and Advantage plans must cover the same services as Original Medicare.
However, Advantage plans may offer additional health coverage, such as prescription drug coverage.
Types of Medicare Advantage plans
There are several types of Advantage plans. Four of the most common ones include:
Health maintenance organizations (HMO) plans provide insurance coverage from doctors and hospitals within a specific network. A person chooses their primary care doctor and may need a referral to see a specialist.
Preferred provider organizations (PPO) plans offer a person the choice of selecting a doctor out of their network, although the cost may increase. A person does not need a referral to see a specialist.
Private fee for service (PFFS) plans do not require a person to choose a primary care doctor or receive a referral to see a specialist. However, out-of-network services typically have higher costs than in-network care.
Special needs plan (SNP) enrollment is limited to a person with specific diseases or conditions. Some plans may require primary care doctors.
Medical Savings Account (MSA) plans involve paying a high deductible for a private insurance plan. They include a health savings account that allows people to save money tax-free to help meet the deductible.
A person can use this online tool to find an Advantage plan in their area.
How can I switch Medicare Advantage plans?
To switch a Medicare Advantage plan, a person can compare the different plans online and choose one that suits them. A person can also call 800-MEDICARE (800-633-4227) to find a plan in their area.
A person can then enroll in the new plan during one of the available enrollment periods. They are automatically disenrolled from their previous plan when coverage from the new plan begins.
When can I switch Medicare Advantage plans?
A person can switch plans during the initial enrollment period (IEP), the Advantage open enrollment period (OEP), the fall OEP, or in special circumstances.
Below are the three enrollment periods when a person can switch plans. Details about the special circumstances period follow them.
Initial enrollment period (OEP)
A person can switch to a Medicare Advantage plan during their OEP.
If a person qualifies because they are turning 65, the initial enrollment begins 3 months before the month they turn 65, includes the birth month, and ends 3 months later.
If a person qualifies for Medicare based on a disability, and gets Social Security disability insurance or Railroad Board benefits, their enrollment period is different. In this case, the enrollment period starts 3 months before they have received benefits for 25 months, including the 25th month, and continues for another 3 months.
Medicare Advantage OEP
A person can switch Medicare Advantage plans during the yearly open enrollment period, which runs from January 1 to March 31. The change in plans takes effect on the first day of the month following the month in which the person enrolls. For instance, if an individual switched plans in January, the new plan coverage starts on February 1.
Fall OEP
During the Fall open enrollment period, from October 15 to December 7, people can choose to switch Medicare Advantage plans. Changes take effect on January 1.
A person can choose to:
switch from one Medicare Advantage plan to another, either with or without a Part D drug plan
switch from Medicare Advantage to Original Medicare, either with or without a Part D drug plan
During this period, a person can not:
Switch from Original Medicare to a Medicare Advantage Plan
Join a separate Medicare drug plan if they have Original Medicare
Switch from one Medicare drug plan to another if they have Original Medicare.
As shown below, A person may also switch Medicare Advantage plans when certain life circumstances occur.
Special enrollment period (SEP)
A person may qualify for a special enrollment period (SEP) because of various circumstances, such as:
moving back to the United States from out of the country
loss of other health insurance
release from jail
moving in or out of a skilled nursing facility
The exact rules for changes allowed during SEPs may vary, so a person should check the details with their Medicare Advantage plan provider.
How do I know if I’m eligible to enroll?
Anyone eligible for Original Medicare is also eligible for a Medicare Advantage plan.
A person is eligible for Original Medicare if they are a U.S. citizen or have held permanent resident status for a minimum of 5 years, and they also meet one or more of the following requirements:
is 65 years or older
has a disability
To qualify for an Advantage plan, a person must have enrolled in Original Medicare or meet eligibility requirements, and live in the insurance plan’s service area.
What about costs?
The costs of Medicare Advantage plans vary and depend on several factors, including where a person lives, the coverage provided by individual plan providers, and the additional benefits offered by some plans.
Medicare Advantage plans may incur the cost of a monthly premium, deductible, and extra benefits that Original Medicare does not cover, such as dental care.
Most Advantage plans also have out-of-pocket costs that a person must meet before health coverage begins. Again, the amounts may vary, and a person can check the details with the plan provider, or use this online comparison tool.
According to the Kaiser Family Foundation (KFF), in 2024, the average enrollment-weighted premium for Medicare Advantage plans was $14 a month. However, for the 25% of beneficiaries enrolled in plans that do require a premium, the average is significantly higher at $56 per month.
It’s important for a person to carefully review plan details to understand the full scope of costs associated with their Medicare Advantage plan.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
Summary
A person can switch Medicare Advantage plans during specific enrollment periods and sometimes during special enrollment periods because of certain circumstances, such as moving to a new location, or losing other health insurance coverage.
View the original article on Medical News Today
